Posterior Cervical Flaps

EDITORIAL COMMENT

This is a very courageous flap; however, the editors caution that this flap may require a preliminary delay because the circulation, when extended into the scalp, appears to be primarily from the temporal vessels anteriorly. The postauricula branches appear to be divided when the long length of this flap is used.

The skin from the back of the neck has not been used often for facial reconstruction. Its use as a random flap raised in vascular areas of the scalp on the neck has been described for the repair of pharyngeal fistulas (1) and for other head and neck defects (2). We have described a posterior cervical flap for facial defects (3).

ANATOMY

The flap depends on the occipital artery for its nutrition, and its base is formed by a horizontal line joining the mastoid process to the midline posteriorly. The flap extends vertically downward to the nape of the neck, up to the D2-3 spinous process (Fig. 120.1). For better reach, the trunk of the occipital artery may be divided and the flap extended into the temporal region, where it depends for its blood supply on the posterior branch of the superficial temporal artery and its anastomosis with the occipital artery (see Fig. 120.3).

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