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Nowadays free tissue transfer is considered the golden slandered in reconstruction of major defects in head and neck regions. Pedicled flaps, however, still have role in high risk patients. Pedicled island LD myocutanious flap can provide a massive amount of tissue that can be utilized and manipulated to reconstruct complex 3D defects with minimal donor site morbidity. Although has been described long time ago, the literature is very deficient regarding methods and techniques to manipulate the flap during transfer and insetting to fit complex two or three layered 3D reconstruction. The aim of this study is to describe our techniques in an algorithmic pattern within the context of our case series. Methods: In this retrospective study we present 32 patients underwent island LD myocutaneous flap for reconstruction of complex head and neck defects (19 patients underwent partial or total pharyngeal reconstruction ± neck skin, and 13 patients underwent lower face ± mandibular reconstruction with intra oral extension). Average age was 56 years and selection criteria for this technique includes; depleted neck vessels from previous surgery, frozen neck after pre-operative radiation together with high risk patients. Technical consideration in flap design and in-setting were reported in details according to the site of reconstruction. Results: We have a single mortality in post-operative period in a medically morbid patient. No whole flap failure in all patients. 2 patients (6.3%) had partial flap loss. Eight patients (25%) had other complications like fistula, wound dehiscence and donor site problems. Recurrence happened in 3 patients. Over all complication rate is 31%. Donor site and wound related complications were treated conservatively however other complications such as flap vascular insult, partial necrosis and delayed fistulas were treated surgically (9.3%). Conclusion: The island subcutaneous LD myocutanious flap is a very useful tool in reconstruction of complex 3D head and neck defects in selected patients. The rate of complications are comparable with free tissue transfer when appropriate techniques are used.

egyptian journal of plastic and reconstructive surgery

Pedicled Island Latissimus Dorsi Myocutaneous Flap in Reconstruction of Complex 3D Head &amp; Neck Defects after Tumor Ablation: Refinement of Flap Insetting Techniques in Selected Patients