Cervicopectoral Skin Flap to The Cheek
D. W. BECKER JR.
The cervicopectoral skin flap is a massive flap of chest and neck skin whose major application is coverage of cheek defects (1).
The most frequent use of this flap has been for primary reconstruction of a cheek defect created after a wide excision of a melanoma, usually with simultaneous total parotidectomy and radical neck dissection. In this situation, elevation of the flap gives excellent exposure for the extirpative phase of the procedure.
The cervicopectoral skin flap is analogous to the familiar deltopectoral flap of Bakamjian (2). The blood supply consists of the internal thoracic artery perforators to the arterialized chest portion of the flap. The attached neck skin was originally considered to be a random portion; however, it has been so robust and reliable that it very likely receives nourishment from platysma musculocutaneous perforators as well.
FLAP DESIGN AND DIMENSIONS
Large full-thickness defects (6-10 cm in diameter) are covered with skin that is similar in color and character. The flap approximates a 30 × 30-cm area. Coverage of the defect is accomplished by a combination of rotation and expansion. The arc of rotation will vary with body build. The flap will reach higher in a short-necked, broad-chested individual than in one of the opposite habitus. In the ideal situation, it will reach cephalad to the zygomatic arch. The flap is totally inset and dog-ears are trimmed so that no further surgery is required.