Trapezius perforator flap for reconstruction of a posterior cervical defect

Nascimento, Ricardo; Costa, Joana; Horta, Ricardo; Silva, Álvaro

doi:10.1016/j.jcot.2017.03.006

Cited by 9 publications

(8 citation statements)

References 7 publications

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“…Of note, no implants had to be removed prior to flap coverage. Our results concur with previous reports in the literature with excellent functional and cosmetic outcomes [5][6][7][8][9]. In our practice, we generally adhere to a staged management concept.…”

Section: Discussionsupporting

confidence: 90%

“…The LTIMF is a well-described pedicled flap offering a high flexibility of inset, and used for a variety of reconstructive procedures from oromaxillofacial to deep tissue defects over the spine. However, reports of the LTIMF for reconstruction of complicated wounds after spine surgery are limited to a few small case series (4 to 6 patients) and case reports, and find little mention in the spine literature [4][5][6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Coverage of complex tissue defects following open cervicothoracic spine surgery with a lower trapezius island myocutaneous flap—an interdisciplinary approach

et al. 2021

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The study design is a clinical case series. The objective of this study was to present the concept and efficacy of the lower trapezius island myocutaneous flap (LTIMF) for management of complex wound healing disorders following open cervicothoracic spine surgery. Wound healing disturbances with myocutaneous defects after open spine surgery at the cervical and upper thoracic spine are well-described complications. In severe cases, plastic reconstructive coverage is often required as a last resort. A review of all adult patients with deep wound dehiscence and tissue defects following open cervicothoracic spine surgery, who were managed with plastic surgery reconstruction using a LTIMF at our institution, was conducted. Synopses of these cases are presented. Seven patients with a mean age of 73 years ± 13 (range 50 to 89 years) were included in this case series. Six out of seven patients had instrumented posterior fusion added to their decompression. All patients were managed with a LTIMF for wound coverage. No spinal implants were removed prior to LTIMF surgery. The mean follow-up was 5.2 months (± 5.4 months). No major flap failure occurred, and all patients presented with satisfactory cosmetic results. The only minor complication was development of a sterile subcutaneous seroma in two patients, which were successfully managed by puncture and aspiration. The LTIMF is an effective and reliable salvage treatment option for spine surgery patients offering stable coverage of deep tissue defects resulting from complex wound healing disorders at the cervical and upper thoracic spine.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Coverage of complex tissue defects following open cervicothoracic spine surgery with a lower trapezius island myocutaneous flap—an interdisciplinary approach

et al. 2021

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“…Several local flaps have been suggested for the closure of the posterior neck and lower occipital scalp defects. Trapezius flaps, including myocutaneous flaps, muscle flaps, lower perforator island flaps, and upper perforator-based bilobed fasciocutaneous flaps, are used in a common local flap technique for reconstruction of the posterior neck and scalp 17–21 . Besides, extended cervicohumeral flaps for posterior neck repair and pedicled island V-Y advancement flaps based on occipital artery perforators for posterior scalp defect coverage have been used as alternative reconstructive options 22,23 .…”

Section: Discussionmentioning

confidence: 99%

Keystone Flaps for Coverage of Defects in the Posterior Neck and Lower Occipital Scalp: A Retrospective Clinical Study

Kong

Kim²,

Shin³

et al. 2021

Journal of Craniofacial Surgery

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The coverage of the posterior neck and lower occipital scalp defects should be approached carefully. Thick, stiff, and inelastic skin properties of these areas tend to make coverage of even small defects difficult. Herein, the authors present a retrospective review of our experience with posterior neck and lower occipital scalp reconstruction using the keystone flap (KF) and describe the expanding versatility of KF reconstruction. The medical records of 17 patients who underwent KF reconstruction to cover the posterior neck and lower occipital defect from April 2017 to May 2020 were reviewed. Clinical and operative data were collected. All defects were successfully covered with the KFs. The defect sizes ranged from 2.5 Â 3.5 cm to 6 Â 11 cm, and the flap sizes ranged from 3 Â 5.5 cm to 9 Â 18 cm. All flaps fully survived, although marginal maceration developed in one case; however, it healed with conservative management. The final results were favorable, and all patients were satisfied with their final outcomes. Consequently, the KF can be considered as a good reconstruction modality with few complications and provides an alternative to other reconstructive options for coverage of the posterior neck and lower occipital defects.

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“…8 As mentioned previously, the dorsal scapular artery perforator flap was selected based on “minimal” donor site morbidity. In previous descriptions, 9,10 the intramuscular dissection of the pedicle involved the deroofing technique popularized by Wei and colleagues. 2 Although this technique facilitates swift skeletonization of the perforators and decreased operative time, it does transect a portion of the muscular fibers.…”

Section: Discussionmentioning

confidence: 99%

The Dorsal Scapular Artery Perforator Flap: A Complete Muscle-sparing Technique

Marr

Varga

Dumestre

2021

Plastic and Reconstructive Surgery - Global Open

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Summary: Cervical and thoracic spine reconstruction can be a difficult area to provide stable soft tissue coverage. Historically, trapezius myocutaneous flaps and trapezius muscle turnover flaps have proven to be reliable and versatile methods for the reconstruction of these areas. However, sequelae such as restriction of shoulder movement have been reported, as well as unsightly “humpback” contour deformities from turnover flap bulk. The use of the trapezius muscle for coverage has evolved to include descriptions of a trapezius perforator flap to address some of the issues of donor site morbidity, as it is described as a muscle-sparing technique. Although described as “muscle-sparing,” these approaches nonetheless involve sacrifice of trapezius muscle overlying the pedicle as that musculature is “deroofed” and divided off the pedicle during dissection. In this article, we present a detailed technical description of our novel technique to the trapezius perforator flap using a dorsal scapular artery flap for spinal reconstruction that is truly, completely muscle-sparing. This technique may prove useful for those patients in which even minimal disruption of trapezius muscle fibers is undesirable.

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Trapezius perforator flap for reconstruction of a posterior cervical defect

Cited by 9 publications

References 7 publications

Coverage of complex tissue defects following open cervicothoracic spine surgery with a lower trapezius island myocutaneous flap—an interdisciplinary approach

Coverage of complex tissue defects following open cervicothoracic spine surgery with a lower trapezius island myocutaneous flap—an interdisciplinary approach

Keystone Flaps for Coverage of Defects in the Posterior Neck and Lower Occipital Scalp: A Retrospective Clinical Study

The Dorsal Scapular Artery Perforator Flap: A Complete Muscle-sparing Technique

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