Transaxillary-Subclavian Transfer of Pedicled Latissimus Dorsi Musculocutaneous Flap to Head and Neck Region

Abstract: Free-tissue transfer is the reconstruction of choice formost head and neck defects. However, pedicled flaps are also used,especially in high-risk patients and after failure of a free flap. Theaim of this study was to compare transaxillary-subclavian pedicledlatissimus dorsi musculocutaneous (PLDMC) flap, pectoralis majormusculocutaneous flap, and free-tissue transfer for head and neckreconstruction in American Society of Anesthesiologists grades IIand III patients.During the last 4 years, PLDMC flap with a modifiedtransaxillary-subclavian route for transfer to the neck was used in8 patients, pectoralis major musculocutaneous flap was used in 7patients, and free flaps were used in 12 patients for head and neckreconstructions. These 3 methods were compared regarding the flapdimensions, complications, flap outcome scores, hospitalizationtime, and cost of the treatment.Mean age of the patients, mean American Society of Anesthesiologists scores, mean dimensions of the flaps, and mean hospitalization time did not differ significantly among the 3 groups. Regardingthe operation time, flap complications, outcomes, and cost of totaltreatment, although statistically not significant, PLDMC group offeredthe fastest reconstruction with highest flap outcome scores andminimum cost.Free-tissue transfer is the procedure of choice especially forfunctional reconstruction of head and neck region. Occasionally,there exist cases in whom a pedicled flap could offer a safer option.The PLDMC flap transferred via the transaxillary-subclavian routemay be preferred than, with advantages including increased arc ofrotation, safer pedicle location, shorter duration of the procedure,and reduced complication rates and costs.Key Words: Head and neck reconstruction, pedicled latissimusdorsi flap, musculocutaneous flap, pectoralis major flap,transaxillary-subclavian transfer, free flap

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