The neck skin has been used as a pedicle-flap donor site by numerous workers (1, 2, 3, 4). Most of the reports deal with neck flaps that are based inferiorly and are migrated in a clockwise direction (5, 6, 7, 8, 9), primarily by stretching the posterolateral neck skin. Such flaps will successfully close sizable cheek defects, but their blood supply is greatly jeopardized by an associated radical neck dissection. The division of the deep fascia requires that all three branches of the supraclavicular plexus of arteries, veins, and nerves be ligated.

Studies have shown that the blood flow in the cervical skin comes from a lateral direction (10). The posteriorly based flap is not compromised by an associated radical neck dissection because muscular branches of the vertebral, occipital, and superior thyroid arteries are not affected by the dissection. Although the posteriorly based cervical skin flap includes the platysma muscle, the blood supply is random in nature.

With the patient supine, the neck is extended and the head is rotated in the opposite direction, thus placing the deep cervical fascia under maximal tension and thereby facilitating elevation of the flap. The flap is based on the anterior border of the trapezius muscle. It is outlined roughly parallel to the mandible over as far as the midline of the neck as a well-rounded structure. The lower border of the flap parallels the clavicle. The degree of rotation depends on the angle. The lower incision follows over the posteroinferior trapezius (Fig. 114.1A).