Abstract
In head and neck cancer patients with significant comorbidities, the reconstructive
options are limited, and there is a need for a safe alternative for microvascular
flaps without compromising flap size. During the study period, 331 head and neck cancer
patients were reconstructed with microvascular tissue flaps. Ten patients requiring
large resections were considered to have high risks for long surgery and to be poor
candidates for free tissue transfer and thus were reconstructed with a subpectorally
tunneled pedicled latissimus dorsi (SP-LD) flap. The flap was raised simultaneously
with the tumor resection and tunneled to the head and neck region. The flap was used
for reconstruction of oral, mandibular, pharyngeal, or neck defects. Median follow-up
was 3.6 years. Median duration of surgery was 7 hours and 17 minutes, and total hospital
stay was 20 days. During the follow-up, four patients died of their disease and one
from another cause (median of 329 days). We were able to perform large tumor resections
with a curative intent and reconstruct major defects in high-risk head and neck cancer
patients with a SP-LD flap. It possesses many of the characteristics of a free flap
with the benefits of a shorter operation time and less perioperative risk.
Keywords
head and neck surgery - reconstruction - latissimus dorsi musculocutaneous flap
