Extended Vertical Lower Trapezius Island Myocutaneous Flap for Repairing Extensive Oropharyngeal Defects

Tumors of the oropharynx are often diagnosed at advanced stages but nonetheless may be treated surgically. Oropharyngeal reconstruction presents a challenge. Several methods of reconstruction have been used, including primary closure, free skin grafts, tongue flaps, buccal fat pads, cheek flaps, myocutaneous flaps, free tissue transfer, and masseter muscle flaps. 1 Advanced tumors and extensive oropharyngeal defects call for alternative approaches to reconstruction. In 1979, Demergasso and Piazza 2 described the trapezius myocutaneous flap, in which the transverse cervical artery and paraspinous attachment of the trapezius were left intact. In 1980, Baek et al 3 first described the lower trapezius island myocutaneous flap (LTIMF) for reconstructing cutaneous defects or performing subcutaneous augmentation of the face. In 2000, Tan and Tan 4 reported the vascular anatomy and clinical use of the extended LTIMF based solely on the dorsal scapular artery system. In 2004, Ugurlu et al 5 proposed using the extended vertical trapezius myocutaneous flap based solely on the transverse cervical artery in a salvage procedure for failed previous flap procedures and tumor recurrence. Because that flap is not an island flap, a second operation is necessary. Here we present our experience with the extended vertical LTIMF for reconstructing larger oropharyngeal defects after the ablation of advanced oropharyngeal squamous cell carcinomas.