Deltopectoral Flap
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Indications • Soft tissue reconstruction of the neck and hypopharynx • Pharyngocutaneous fistulas • “Backup” flap Circulation • Septocutaneously: Randomly through skin perforators from the internal mammary artery. Constituents • Fasciocutaneous: Skin and fascia overlying the chest and shoulder Contiguity • Local and regional Construction • Unipedicled Conditioning • Delay and subsequent two-stage reconstruction possible Conformation • The skin island is oriented to the shape of the defect. • The flap can be tubed for pharyngeal reconstruction.
B.M. Erovic, P. Lercher, Manual of Head and Neck Reconstruction Using Regional and Free Flaps, DOI 10.1007/978-3-7091-1172-7_22, © Springer-Verlag Wien 2015
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22 Deltopectoral Flap
Dr. Vahram Y. Bakamjian introduced the deltopectoral flap in the 1960s for reconstruction of hypopharyngeal and neck defects.
Anatomy The surface of the ventral portion of the shoulder and the chest consists of smooth and movable skin, with the fascia overlying the deltoid and pectoral major muscle and the clavicle (Fig. 22.1). 22.1
Disadvantages
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Blood Supply Blood supply to the skin is mainly provided by small perforator arteries derived from the internal mammary artery. Additionally, small skin perforators exit the chest wall between the ribs to supply the skin.
Innervation As described with regard to the supraclavicular flap, the skin overlying the shoulder and the anterior chest is innervated by the supraclavicular nerves (C3 and C4) from the cervical plexus and the anterolateral intercostal nerves (T2–T4).
Indications The deltopectoral flap, a thin axial fasciocutaneous flap, is used: • For reconstruction of soft tissue defects: –– After tumor excision in the neck –– Hypopharyngeal defects –– Wound dehiscence in the neck • To cover pharyngocutaneous fistulas or exposed vessels of the neck, i.e., carotid artery and internal jugular vein • As a “backup” flap for various failed pedicle or free tissue flaps
Advantages • Easy and rapid harvesting of a very reliable and thin flap. • Excellent color match with the face. • “Backup” flap after reconstruction with a pectoralis major or free flap.
Disadvantages • Patients’ poor acceptance of esthetics at the donor site after split-thickness skin grafting. • Extensive scarring of the chest, especially in women. • Hairy skin paddle in men. • Development of seroma or hematoma at the donor site.
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22 Deltopectoral Flap
Preoperative Considerations • Rule out previous trauma or surgery to the flap donor site. • Prepare and drape a donor site for skin graft harvesting.
Surgical Steps 1. The incision is marked over the shoulder and the anterior chest wall (Fig. 22.2). Shrinkage of approximately 10 % over time should be taken into account when designing the skin island. 22.2
2. The skin incision is performed over the deltoid muscle, and flap elevation is started in the lateral aspect, deep to the deltoid and pectoral major muscle fascia (Fig. 22.3a, b). 22.3a
22.3b
Surgical Steps
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3. Note the deltopectoral
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