The contralateral bilobed trapezius myocutaneous flap for closure of large defects of the dorsal neck permitting primary donor site closure.

Abstract

Various reliable local flaps can be used to cover soft tissue defects of the posterior neck. Among others, the (either vertical or transverse) trapezius myocutaneous flap is a reliable option in this context. However, for defects with a diameter larger than 15 cm, these flaps require skin grafting of the donor site. To prevent this additional morbidity we describe a contralaterally based bilobed trapezius musculocutaneous flap successfully applied in two elderly patients with large tumors of the posterior neck in palliative situations. This novel approach makes use of a standard vertical skin paddle to cover the neck, together with a transverse cervical flap in a bilobed design to primarily close the paravertebral donor site. The bilobed technique allows the primary closure of massive soft tissue neck wounds. Preservation of the accessory nerve to the superior fibers of the trapezius muscle permitted normal arm elevation in our patients.