Lateral Neck Reconstruction

Clinical Presentation

An 89-year-old White male developed a recurrent squamous cell cancer (SCC) over his right upper lateral neck with a large, ulcerated lesion. He had an SCC resection in the same area many years before. The patient was referred by the surgical oncology service for soft tissue reconstruction after a planned wide local excision of this recurrent SCC lesion. He also had a planned postoperative radiation after surgical resection ( Fig. 12.1 ).

Operative Plan and Special Considerations

For an anticipated large soft tissue defect down to the underlying bone and future postoperative radiation, a reliable soft tissue reconstruction should be performed. Based on the anticipated location and size of the soft tissue defect, a distant flap with a relatively long pedicle should be selected. The pectoralis major myocutaneous flap is a reliable flap and can reach the level of the zygomatic arch. It would be an ideal distant flap to be selected for the reconstruction. The flap can be elevated with a skin paddle and tunneled through the neck to reach the soft tissue defect and provide a good soft tissue coverage following the wide local resection. Other options such as a supraclavicular artery island flap, trapezius myocutaneous flap, or submental island flap can also be considered. However, those flaps are less consistent and reliable than the pectoralis major myocutaneous flap for this type of reconstruction.

Operative Procedures

Under general anesthesia, a wide local resection of the recurrent SCC in the area was performed by the surgical oncology service without difficulty. There was an 8 × 5 cm soft tissue defect down to the underlying the mastoid and ear canal ( Figs. 12.2 and 12.3 ). The results from an intraoperative frozen section showed all soft tissue margins to be negative.