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Single-stage reconstruction of composite central neck defects with the double-island vertical rectus abdominis musculocutaneous flap

Evan Matros, Peter G Cordeiro
Annals of Plastic Surgery 2011, 66 (2): 164-7

BACKGROUND: A subset of patients with hypopharyngeal cancer has tumors involving the neck skin and soft tissues in addition to vital structures such as the larynx and alimentary tract. Surgical extirpation creates a complex composite deformity for the reconstructive surgeon. The objective of this article is to describe the rationale for closure of these defects with the double-island vertical rectus abdominis musculocutaneous (VRAM) flap.

METHODS: Retrospective chart review of all head and neck reconstructions performed over the past 20 years identified 4 patients who underwent reconstruction of combined defects involving less than 50% of the pharyngoesophageal circumference and anterior neck soft tissues. All wounds were closed in a single-stage with a double-island VRAM. Outcomes and complications were reviewed.

RESULTS: Indication for resection was locally advanced disease or recurrence with pharyngocutaneous fistula. Mean age was 54 years with a follow-up time of 2 years. The average external skin defect measured 10 × 15 cm. There was no complete or partial flap loss. No major and 2 minor complications were identified. All patients tolerated an oral diet postoperatively. No revisions have been performed.

CONCLUSION: In contrast to perforator flaps where creation of separate skin paddles may not always be possible, the VRAM's robust axial blood supply facilitates formation of 2 independent skin islands in all cases. The external island serves as a flap monitor and obviates the need for a second flap. In conclusion, the double-island VRAM flap is safe, has minimal donor-site morbidity, and reliably accomplishes reconstruction of composite head and neck defects in a single-stage.

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