Introduction: 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.