Cervical Skin Flap for Intraoral Lining
V. Y. BAKAMJIAN
Before the post-World War II era of advances in reconstructive surgery, most repairs after cancer surgery of the head and neck involved direct suturing of oral wound edges. Reconstruction was often postponed for an arbitrary 6 or 12 months to rule out recurring cancer before embarking on a protracted plan of reconstruction with flaps migrated from distant sites.
The next reconstructive advance—choosing cervical skin to replace losses of oral lining—seemed a natural choice (1, 2, 3, 4). A skin flap could be outlined on the neck in either a transverse, oblique, or vertically downward direction from a superolateral base below the mastoid process and angle of the mandible (Fig. 188.1A). This location was chosen for its proximity to oral sites as well as for the blood supply from branches of the external carotid artery.
In view of the limitations imposed on the use of cervical skin following radical neck dissection, however, it is not at all surprising that cervical neck flaps have been almost completely abandoned for intraoral lining in favor of later more versatile techniques that followed the introduction of deltopectoral (5, 6), musculocutaneous (7, 8), and free flaps (9, 10).
Advantages of the cervical skin flap are (a) proximity for direct transfer to intraoral common defects, (b) thinness and pliability of the flap, (c) better than average random-pattern vascularity than in skin on the torso or extremities, and (d) the laxity of aging cervical skin from which it is convenient to borrow flap material. In the form described herein, it is capable of lining moderate-sized oral defects fairly well, leaving only an inconspicuous linear scar on the neck.