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J Reconstr Microsurg
DOI: 10.1055/s-0044-1787741
Original Article

The Forgotten Flap: The Pedicled Trapezius Flap's Utility in Pediatric Head and Neck Reconstruction—A Systematic Review

Tayla Moshal
1   Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
2   Keck School of Medicine, University of Southern California, Los Angeles, California
,
Sasha Lasky
1   Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
2   Keck School of Medicine, University of Southern California, Los Angeles, California
,
Idean Roohani
1   Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
2   Keck School of Medicine, University of Southern California, Los Angeles, California
,
Marah I. Jolibois
1   Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
,
Artur Manasyan
2   Keck School of Medicine, University of Southern California, Los Angeles, California
,
Naikhoba C.O. Munabi
1   Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
,
Artur Fahradyan
1   Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
,
Jessica A. Lee
1   Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
3   Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, California
,
Jeffrey A. Hammoudeh
1   Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
3   Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, California
› Author Affiliations Funding None.
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Abstract

Background When free tissue transfer is precluded or undesired, the pedicled trapezius flap is a viable alternative for adults requiring complex head and neck (H&N) defect reconstruction. However, the application of this flap in pediatric reconstruction is underexplored. This systematic review aimed to describe the use of the pedicled trapezius flap and investigate its efficacy in pediatric H&N reconstruction.

Methods A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles describing the trapezius flap for H&N reconstruction in pediatric patients were included. Patient demographics, surgical indications, wound characteristics, flap characteristics, complications, and functional outcomes were abstracted.

Results A systematic review identified 22 articles for inclusion. Studies mainly consisted of case reports (n = 11) and case series (n = 8). In total, 67 pedicled trapezius flaps were successfully performed for H&N reconstruction in 63 patients. The most common surgical indications included burn scar contractures (n = 46, 73.0%) and chronic wounds secondary to H&N masses (n = 9, 14.3%). Defects were most commonly located in the neck (n = 28, 41.8%). The mean flap area and arc of rotation were 326.4 ± 241.7 cm2 and 157.6 ± 33.2 degrees, respectively. Most flaps were myocutaneous (n = 48, 71.6%) and based on the dorsal scapular artery (n = 32, 47.8%). Complications occurred in 10 (14.9%) flaps. The flap's survival rate was 100% (n = 67). No instances of functional donor site morbidity were reported. The mean follow-up was 2.2 ± 1.8 years.

Conclusion This systematic review demonstrated the reliability of the pedicled trapezius flap in pediatric H&N reconstruction, with a low complication rate, no reports of functional donor site morbidity, and a 100% flap survival rate. The flap's substantial surface area, bulk, and arc of rotation contribute to its efficacy in covering soft tissue defects ranging from the proximal neck to the vertex of the scalp. The pedicled trapezius flap is a viable option for pediatric H&N reconstruction.

Keywords

pediatric - head and neck - trapezius flap

Supplementary Material



Publication History

Received: 20 February 2024

Accepted: 05 May 2024

Article published online:
25 June 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Deganello A, Manciocco V, Dolivet G, Leemans CR, Spriano G. Infrahyoid fascio-myocutaneous flap as an alternative to free radial forearm flap in head and neck reconstruction. Head Neck 2007; 29 (03) 285-291
    CrossrefPubMedGoogle Scholar
  • 2 Singh M, Rios Diaz AJ, Cauley R, Smith TR, Caterson EJ. Use of pedicled trapezius myocutaneous flap for posterior skull reconstruction. J Craniofac Surg 2015; 26 (06) e532-e535
    CrossrefPubMedGoogle Scholar
  • 3 Serletti JM, Higgins JP, Moran S, Orlando GS. Factors affecting outcome in free-tissue transfer in the elderly. Plast Reconstr Surg 2000; 106 (01) 66-70
    CrossrefPubMedGoogle Scholar
  • 4 van Rossen MEE, Verduijn PV, Mureau MAM. Survival of pectoralis major flap after secondary myectomy of muscle pedicle including transection of thoracoacromial vessels: Does the flap remain dependent on its dominant?. J Plast Reconstr Aesthet Surg 2011; 64: 323-328 . Accessed May 28, 2024 at: https://www.sciencedirect.com/science/article/pii/S1748681510003268
    CrossrefPubMedGoogle Scholar
  • 5 Maves MD, Panje WR, Shagets FW. Extended latissimus dorsi myocutaneous flap reconstruction of major head and neck defects. Otolaryngol Head Neck Surg 1984; 92 (05) 551-558
    CrossrefPubMedGoogle Scholar
  • 6 Zenga J, Sharon JD, Santiago P. et al. Lower trapezius flap for reconstruction of posterior scalp and neck defects after complex occipital-cervical surgeries. J Neurol Surg B Skull Base 2015; 76 (05) 397-408
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Chen W-L, Yang Z-H, Li J-S, Huang Z-Q. Reconstruction of the tongue using an extended vertical lower trapezius island myocutaneous flap after removal of advanced tongue cancer. Br J Oral Maxillofac Surg 2008; 46 (05) 379-382
    CrossrefPubMedGoogle Scholar
  • 8 Grabb WC. Grabb and Smith's Plastic Surgery. Wolters Kluwer Health/Lippincott Williams & Wilkins; 2007
    Google Scholar
  • 9 Yang HJ, Lee DH, Kim YW, Lee SG, Cheon YW. The trapezius muscle flap: a viable alternative for posterior scalp and neck reconstruction. Arch Plast Surg 2016; 43 (06) 529-535
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Hyakusoku H, Yoshida H, Okubo M, Hirai T, Fumiiri M. Superficial cervical artery skin flaps. Plast Reconstr Surg 1990; 86 (01) 33-38
    CrossrefPubMedGoogle Scholar
  • 11 Hyakusoku H, Takizawa Y, Murakami M, Gao JH, Takekoshi A, Fumiiri M. Versatility of the free or pedicled superficial cervical artery skin flaps in head and neck burns. Burns 1993; 19 (02) 168-173
    CrossrefPubMedGoogle Scholar
  • 12 Nakajima H, Fujino T. Island fasciocutaneous flaps of dorsal trunk and their application to myocutaneous flap. Keio J Med 1984; 33 (02) 59-82
    CrossrefPubMedGoogle Scholar
  • 13 Demergasso F, Piazza MV. Trapezius myocutaneous flap in reconstructive surgery for head and neck cancer: an original technique. Am J Surg 1979; 138 (04) 533-536
    CrossrefPubMedGoogle Scholar
  • 14 Chen W-L, Yang Z-H, Zhang D-M, Huang Z-Q, Fan S, Wang L. Reconstruction of major full cheek defects with combined extensive pedicled supraclavicular fasciocutaneous island flaps and extended vertical lower trapezius island myocutaneous flaps after ablation of advanced oral cancer. J Oral Maxillofac Surg 2012; 70 (05) 1224-1231
    CrossrefPubMedGoogle Scholar
  • 15 Ulrich D, Fuchs P, Pallua N. Preexpanded vertical trapezius musculocutaneous flap for reconstruction of a severe neck contracture after burn injury. J Burn Care Res 2008; 29 (02) 386-389
    CrossrefPubMedGoogle Scholar
  • 16 Ou K-L, Dai Y-H, Wang H-J. et al. The lower trapezius musculocutaneous flap for head and neck reconstruction: two decades of clinical experience. Ann Plast Surg 2013; 71 (Suppl. 01) S48-S54
    CrossrefPubMedGoogle Scholar
  • 17 Lynch JR, Hansen JE, Chaffoo R, Seyfer AE. The lower trapezius musculocutaneous flap revisited: versatile coverage for complicated wounds to the posterior cervical and occipital regions based on the deep branch of the transverse cervical artery. Plast Reconstr Surg 2002; 109 (02) 444-450
    CrossrefPubMedGoogle Scholar
  • 18 Zheng X-Y, Guo X, Wang T-L, Wang J-Q. Extended lower trapezius myocutaneous flap in burn scar reconstruction of the face and neck of children. Pediatr Surg Int 2011; 27 (12) 1295-1300
    CrossrefPubMedGoogle Scholar
  • 19 Uğurlu K, Ozçelik D, Hüthüt I, Yildiz K, Kilinç L, Baş L. Extended vertical trapezius myocutaneous flap in head and neck reconstruction as a salvage procedure. Plast Reconstr Surg 2004; 114 (02) 339-350
    CrossrefPubMedGoogle Scholar
  • 20 Motamed S, Davami B, Daghagheleh H. Trapezius musculocutaneous flap in severe shoulder and neck burn. Burns 2004; 30 (05) 476-480
    CrossrefPubMedGoogle Scholar
  • 21 Parekh A, Vecchiotti M, O'Leary M, Scott A. Lower island trapezius myocutaneous flap reconstruction of a large neck defect in an infant. Int J Pediatr Otorhinolaryngol 2012; 76 (12) 1852-1854
    CrossrefPubMedGoogle Scholar
  • 22 Akbay E, Aydogan F, Ucak M. Orbitomaxillomandibular reconstruction with free osteomyocutaneous fibular flap and lower trapezius myocutaneous flap. J Craniofac Surg 2013; 24 (04) e438-e441
    CrossrefPubMedGoogle Scholar
  • 23 Can A, Orgill DP, Dietmar Ulrich JO, Mureau MAM. The myocutaneous trapezius flap revisited: a treatment algorithm for optimal surgical outcomes based on 43 flap reconstructions. J Plast Reconstr Aesthet Surg 2014; 67 (12) 1669-1679
    CrossrefPubMedGoogle Scholar
  • 24 Chen W, Yang Z, Zhang D, Wang Y, Fan S, Huang Z. Second salvage surgery with extended vertical lower trapezius island myocutaneous flap reconstruction for advanced re-recurrent oral and oropharyngeal squamous cell carcinoma. Int J Oral Maxillofac Implants 2014; 43 (05) 531-538
    CrossrefPubMedGoogle Scholar
  • 25 Nakamura A, Aihara Y, Chiba K, Matsumine H, Sakurai H, Kawamata T. Efficacy of the pedicle trapezius muscle flap for the multisurgical removal of pediatric posterior fossa anaplastic ependymoma. Childs Nerv Syst 2023; 39 (06) 1635-1639
    CrossrefPubMedGoogle Scholar
  • 26 Wathne JT, Patow CA. The trapezius myocutaneous flap. Ear Nose Throat J 1992; 71 (04) 167-171
    CrossrefPubMedGoogle Scholar
  • 27 Rosen HM. The extended trapezius musculocutaneous flap for cranio-orbital facial reconstruction. Plast Reconstr Surg 1985; 75 (03) 318-327
    CrossrefPubMedGoogle Scholar
  • 28 Feng AL, Nasser HB, Rosko AJ. et al. Revisiting pedicled latissimus dorsi flaps in head and neck reconstruction: contrasting shoulder morbidities across myofascial flaps. Plast Aesthet Res 2021; 8: 14
    PubMedGoogle Scholar
  • 29 Singh A, Agarwal M, Singh N, Chaturvedi H, Venkatasubramaniyan M, Chopra A. Utility and relevance of modified lateral trapezius myocutaneous flap as a locoregional reconstructive option for medium-sized ablative defects in head and neck cancer-our experience. Eur Arch Otorhinolaryngol 2020; 277 (09) 2539-2549
    CrossrefPubMedGoogle Scholar
  • 30 Wei F-C, Mardini S. Flaps and Reconstructive Surgery E-Book. Elsevier Health Sciences; 2016
    Google Scholar
  • 31 Dziechciaż M, Filip R. Biological psychological and social determinants of old age: bio-psycho-social aspects of human aging. Ann Agric Environ Med 2014; 21 (04) 835-838
    CrossrefPubMedGoogle Scholar
  • 32 Farr JN, Almeida M. The spectrum of fundamental basic science discoveries contributing to organismal aging. J Bone Miner Res 2018; 33 (09) 1568-1584
    CrossrefPubMedGoogle Scholar
  • 33 Khosa S, Trikamji B, Khosa GS, Khanli HM, Mishra SK. An overview of neuromuscular junction aging findings in human and animal studies. Curr Aging Sci 2019; 12 (01) 28-34
    CrossrefPubMedGoogle Scholar
  • 34 Ohlendieck K. Proteomic profiling of fast-to-slow muscle transitions during aging. Front Physiol 2011; 2: 105
    PubMedGoogle Scholar
  • 35 Lirio-Romero C, Palomo-Carrión R, Romay-Barrero H, Ferri-Morales A, Prieto-Gómez V, Torres-Lacomba M. Age differences in motor recruitment patterns of the shoulder in dynamic and isometric contractions. A cross-sectional study. J Clin Med 2021; 10 (03) 525
    CrossrefPubMedGoogle Scholar
  • 36 Sanders O, Hsiao HY, Savin DN, Creath RA, Rogers MW. Aging changes in protective balance and startle responses to sudden drop perturbations. J Neurophysiol 2019; 122 (01) 39-50
    CrossrefPubMedGoogle Scholar
  • 37 Upton J, Guo L. Pediatric free tissue transfer: a 29-year experience with 433 transfers. Plast Reconstr Surg 2008; 121 (05) 1725-1737
    CrossrefPubMedGoogle Scholar
  • 38 Ahmadi M, Karlsen A, Mehling J, Soendenbroe C, Mackey AL, Hyldahl RD. Aging is associated with an altered macrophage response during human skeletal muscle regeneration. Exp Gerontol 2022; 169: 111974
    CrossrefPubMedGoogle Scholar
  • 39 Bolitho DG, Boustred M, Hudson DA, Hodgetts K. Primary epineural repair of the ulnar nerve in children. J Hand Surg Am 1999; 24 (01) 16-20
    CrossrefPubMedGoogle Scholar
  • 40 Pestronk A, Drachman DB, Griffin JW. Effects of aging on nerve sprouting and regeneration. Exp Neurol 1980; 70 (01) 65-82
    CrossrefPubMedGoogle Scholar
  • 41 Strickland JW. Bone, nerve, and tendon injuries of the hand in children. Pediatr Clin North Am 1975; 22 (02) 451-463
    CrossrefPubMedGoogle Scholar
  • 42 Chemnitz A, Andersson G, Rosén B, Dahlin LB, Björkman A. Poor electroneurography but excellent hand function 31 years after nerve repair in childhood. Neuroreport 2013; 24 (01) 6-9
    CrossrefPubMedGoogle Scholar
  • 43 Langridge B, Griffin MF, Akhavani MA, Butler PE. Long-term outcomes following pediatric peripheral nerve injury repair. J Hand Microsurg 2020; 12 (01) 27-31
    Article in Thieme ConnectPubMedGoogle Scholar
  • 44 Fleurette J, Gaume M, De Tienda M, Dana C, Pannier S. Peripheral nerve injuries of the upper extremity in a pediatric population: outcomes and prognostic factors. Hand Surg Rehabil 2022; 41 (04) 481-486
    CrossrefPubMedGoogle Scholar
  • 45 Vajramani A, Witham FM, Richards RH. Congenital unilateral absence of sternocleidomastoid and trapezius muscles: a case report and literature review. J Pediatr Orthop B 2010; 19 (05) 462-464
    CrossrefPubMedGoogle Scholar
  • 46 Allouh M, Mohamed A, Mhanni A. Complete unilateral absence of trapezius muscle. McGill J Med 2020; 8 (01) 31-33
    CrossrefPubMedGoogle Scholar
  • 47 Jacob LM, Dong W, Chang DW. Outcomes of reconstructive surgery in pediatric oncology patients: review of 10-year experience. Ann Surg Oncol 2010; 17 (10) 2563-2569
    CrossrefPubMedGoogle Scholar
  • 48 Tran TH, Hayden JB, Gazendam AM, Ghert M, Gundle KR, Doung Y-C. PARITY Investigators. Pediatric and adult patients have similar functional improvement after endoprosthetic reconstruction of lower-extremity tumors. J Bone Joint Surg Am 2023; 105 (Suppl. 01) 22-28
    CrossrefPubMedGoogle Scholar
  • 49 Raad M, Amin RM, El Abiad JM, Puvanesarajah V, Best MJ, Oni JK. Preoperative patient functional status is an independent predictor of outcomes after primary total hip arthroplasty. Orthopedics 2019; 42 (03) e326-e330
    CrossrefPubMedGoogle Scholar
  • 50 von Moos R, Body J-J, Guenther O. et al. Healthcare-resource utilization associated with radiation to bone across eight European countries: results from a retrospective study. J Bone Oncol 2018; 10: 49-56
    CrossrefPubMedGoogle Scholar
  • 51 Wang M, Zang M, Zhu S. et al. Lower trapezius myocutaneous propeller flap based on dorsal scapular artery. Ann Plast Surg 2022; 89 (05) 502-509
    CrossrefPubMedGoogle Scholar
  • 52 Boissiere F, Gandolfi S, Riot S. et al. Flap venous congestion and salvage techniques: a systematic literature review. Plast Reconstr Surg Glob Open 2021; 9 (01) e3327
    CrossrefPubMedGoogle Scholar
  • 53 Wang M, Zang M, Zhu S. et al. Utility of indocyanine green angiography for preventing pre-expanded extended lower trapezius myocutaneous flap necrosis: how to make the correct decision for hypoperfused areas. J Reconstr Microsurg 2023; 39 (05) 383-391
    Article in Thieme ConnectPubMedGoogle Scholar
  • 54 Singhal M, Sabapathy SR, Gupta D. et al. First successful separation of craniopagus twins in India–plastic surgical considerations. Indian J Plast Surg 2022; 55 (01) 36-44
    Article in Thieme ConnectPubMedGoogle Scholar