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Jonathan E. Aviv, MD; Mark L. Urken, MD; William Lawson, MD, DDS; Hugh F. Biller, MD

Arch Otolaryngol Head Neck Surg. 1992;118(7):702-706.

Abstract
• The superior trapezius myocutaneous flap, based on the paraspinous perforating branches of the intercostal vessels, is generally not a first-line choice for reconstruction of head and neck defects. However, after wound breakdown following radical neck dissection and radiation therapy, the superior trapezius flap is extremely reliable for coverage of exposed major neck vessels. The flap was used in 30 patients undergoing lateral neck reconstruction. All 30 patients had undergone prior neck dissection and all but two had undergone prior radiation therapy. There were no flap failures. The superior trapezius flap is unique among other regional myocutaneous flaps presently in use in that it has a superiorly based pedicle, which reduces the problem of gravitational pull on the suture lines of severely unfavorable recipient beds. Another advantage of using the denervated muscle of this flap is that it imposes no additional functional loss. The deficiencies of this flap are primarily related to its limited arc of rotation, thereby precluding its use when resurfacing defects that extend beyond the midline of the neck. The reliability of the superior trapezius flap after neck dissection can be explained by the angiosome concept. Based on that concept, previous ligation of the transverse cervical vessels during a neck dissection serves to simultaneously stage this flap, thereby improving its reliability and potential surface area available.

(Arch Otolaryngol Head Neck Surg. 1992;118:702-706)

Author Affiliations
From the Department of Otolaryngology, College of Physicians and Surgeons, Columbia University (Dr Aviv); and the Department of Otolaryngology, Mount Sinai Medical Center (Drs Urken, Lawson, and Biller), New York, NY.

Footnotes
Accepted for publication November 5, 1991.

Presented at the annual meeting of the American Society for Head and Neck Surgery, May 7, 1991, Waikoloa, Hawaii.

Reprint requests to the Department of Otolaryngology, Columbia-Presbyterian Medical Center, 630 W 168th St, Box 21, New York, NY 10032 (Dr Aviv).

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