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Archived Comments for: Cervicopectoral flap in head and neck cancer surgery

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  1. The cervicopectoral flap with its disadvantages...

    Murat Enoz, Medicine Faculty of Istanbul University

    13 March 2005

    Reconstruction of surgical or traumatic soft tissue facial defects has long presented a challenge to the oral and maxillofacial surgeon. The ideal flap should provide excellent color, match the texture of the tissues of the face, adequately restore facial contour, place scars in a favorable location, and ideally accomplishthese goals in a single stage with minimal donor site morbidity [1,2,3].

    The resection of a wide margin of soft tissue of the cheek is mandatory when tumors break through the skin. Large defects of the cheek can also be caused by trauma. One of the most challenging problems in this group of patients is closure of the wound. Because such defects are so obvious, a good cutaneous color and texture match is essential. This is best provided by a cervicopectoral flap because it carries adjacent facial and cervical skin into the defect [4].However, this flap requires skin grafting to close the donor site and a second stage to complete the operation. It also has a poor match for color and texture. İn this technical innovations paper Eray et al. didn’t use the skin graft for close the donor area with single incision technique.

    Another major disadvantage of the pectoralis major musculocutaneous flap for cheek reconstruction is its excessive thickness [1,4].

    In tumor patients, oncologic principles are not violated with this flap because the excision margins of the primary site are not compromised for fear of creating too large a surgical defect. The surgeon will have plentiful tissue with which to perform the reconstruction. Also, the plane of elevation of the flap in the neck is identical to that used in radical neck dissection operations, and adequate access is gained to the whole neck dissection field [5].

    References

    1. DW Becker, A cervicopectoral rotation flap for cheek coverage. Plast Reconstr Surg 61 (1978), p. 868.

    2. KC Shestak, AG Roth, NF Jones et al., The cervicopectoral rotation flap: A valuable technique for facial reconstruction. Br J Plast Surg 46 (1993), p. 357.

    3. J Skow, One-stage reconstruction of full thickness cheek defects. Plast Reconstr Surg 71 (1983), p. 855.

    4. Nicolas Lazaridis, Ioannis Tilaveridis, Styllianos Dalambiras and Savas Iordanidis. The fasciocutaneous cervicopectoral rotation flap for lower cheek reconstruction: Report of three cases. Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 10, October 1997, Pages 1166-1171.

    5. Lasaridis, S Dalabiras and D Karakasis, Modification of the Conley Incision for neck dissection. J Oral Maxillofac Surg 52 (1994), p. 1046.

    Competing interests

    Despite its disadvantages, the cervicopectoral rotation flap is a reliable and that fulfills many of the criteria for the reconstruction of large defects of the head and neck area.

    Sincerely yours

    Dr.Murat Enoz

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