Deltopectoral Flap in the Era of Microsurgery

Background. Our study aimed to review the role of deltopectoral (DP) flap as a reconstructive option for defects in the head and neck region in the microvascular era. Methods. All patients who received DP flap reconstruction surgery at the Department of Surgery, Queen Mary Hospital, between 1999 and 2011 were recruited. Demographic data, indications for surgery, defect for reconstruction, and surgical outcomes were analyzed. Results. Fifty-four patients were included. All but two patients were operated for reconstruction after tumour resection. The remaining two patients were operated for necrotizing fasciitis and osteoradionecrosis. The majority of DP flaps were used to cover neck skin defect (63.0%). Other reconstructed defects included posterior pharyngeal wall (22.2%), facial skin defect (11.1%), and tracheal wall (3.7%). All donor sites were covered with partial thickness skin graft. Two patients developed partial flap necrosis at the tip and were managed conservatively. The overall flap survival rate was 96.3%. Conclusions. Albeit the technical advancements in microvascular surgery, DP still possesses multiple advantages (technical simplicity, reliable axial blood supply, large size, thinness, and pliability) which allows it to remain as a useful, reliable, and versatile surgical option for head and neck reconstruction. 1. Background The deltopectoral (DP) flap, also called by some as the Bakamjian flap [1], was actually first described by Aymard in 1917 [2]. Aymard described raising a medially based fasciocutaneous flap from the shoulder skin which was then tubed and used for staged nasal reconstruction [2]. In 1931, Joseph, using illustrations of Manchot from 1889, justified and published illustrations of DP flaps as vascularized pattern flaps [3, 4]. The DP flap, however, did not spark much interest until it was reintroduced by Bakamjian in 1965. Bakamjian reported the use of DP for pharyngoesophageal reconstruction after laryngopharyngectomy [1]. The DP flap became the “workhorse” flap for head and neck reconstruction and enjoyed great popularity in the 1960s, but its popularity gradually faded out with the advent of pedicled myocutaneous flaps and microvascular free flaps. DP flap is thin and pliable and has excellent colour and texture match with the head and neck area. Its reliable anatomy allows quick and easy harvest. A large flap can be harvested, especially with a delayed procedure. Its donor site has minimal functional deficit and can be easily concealed. The flap can be used even in patients who had previous pectoralis major flap if