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CONTENTS
Introduction History Anatomy Indications Technique Complications Advantages Disadvantages
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INTRODUCTION
The current treatment objective of head and
neck cancer patient is the removal of the tumor and to preserve and restore preoperative activity and quality of life.
structures such as the brain, eye or major neurovascular structures is observed which cannot be left as such.
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based on various aspects such as the size, the site and suitability
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Surgical options for head and neck reconstruction have been described schematically as a ladder:
Direct closure Skin grafting Local flaps Distant flaps Cutaneous and myocutaneous pedicled flaps Microvascular free flaps
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consisting an entire thickness of skin and variable amount of the underlying subcutaneous tissue. defect leaving behind a secondary defect which may be closed by direct suturing or a skin graft.
the tissue at a distance from the primary defect then it is called a distant flap.
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HISTORY
The deltopectoral flap was the workhorse for
It was first described by BAKAMJIAN in 1965. It was the first axial pattern skin flap derived
from an outside area for direct reconstruction of head and neck region.
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FLAP DESIGN
The skin of the thorax is supplied by a
combination of direct cutaneous vessels and musculocutaneous perforators which reach the skin primarily via the intercostal muscles, pectoralis major and other muscles. i.e. it is constructed around an arteriovenous system and designed on the anterior superior chest wall.
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second, and third perforators (sometimes the fourth also) of the internal mammary artery and associated veins. axial pattern as the vascular system of the flap ends at the groove separating the deltoid from the pectoralis major muscle.
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the sternal edge, where the perforators pierce in the intercoastal space. deep fascia and the pectoralis major muscle.
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shows exposed pectoralis major muscle which may be closed by either direct closure or by placing a skin graft as it is an ideal site for the same . cases where the bridge segment of the deltopectoral flap is returned to its original site after the division of the flap. line of the deltoid muscle.
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PLANNING OF FLAP
The deltopectoral flap for planning can be
viewed as a very large transposed flap with a pivot point from which the measurements are made. presence of slack skin over the anterior axillary fold.
optimal flap.
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upper border so any tension during the placement of the flap is transferred to the short upper border, in order to avoid this, the measurements are taken from the medial point of the upper border. ( McGregor & Jackson 1970)
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TECHNIQUE
Patient is draped and painted, placed in
supine position.
surgeons convenience.
Land marks sternal edge infraclavicular line deltopectoral groove nipple.
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edge, follows the infraclavicular line beyond the deltopectoral groove onto the anterior shoulder.
extending to the line of the anterior axillary fold above the fifth thoracic intercoastal space ( a few cms above the undisplaced nipple)
The distal incision is placed through the skin
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Elevation proceeds from distal to proximal. Fascia overlying the muscle is included in the
flap.
a relatively bloodless plane across the deltoid, the deltopectoral groove and onto the pectoralis major muscle. perforators are seen emerging through the pectoralis major muscles.
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adjacent skin of the neck in cancer cases where skin of neck is involved.
subcutaneously with the flap pedicle deepithilialized leaving the distal portion like an island flap. Such a flap is used for covering high cervical defects. and the distal part is used for reconstruction.
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divided and the proximal divided portions of the flap are inset, it is done 2 to 3 weeks after the initial procedure.
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COMPLICATIONS
Infection of the flap. Necrosis may have many reasons as tension
on the flap, trauma to the vessels during raising or due to faulty flap design i.e. straight line extensions to the shoulder or L shaped extension oh to the upper arm.
Extensions of this flap are not recommended. Late sequel as fistula and strictures.
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INDICATIONS
Reconstruction after head and neck tumor
excision. closure.
defects.
postburn head and neck reconstruction perioral reconstruction after ballistic trauma Hypo pharyngeal reconstruction.
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CONTRAINDICATIONS
Prior chest wall surgery or injury eg radical
mastectomy, pacemaker
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ADVANTAGES
The deltopectoral flap does not require prior
choosing only one perforator vessel system generally second one is used.
Less donor site morbidity is seen. Accurately replaces the components of the
recipient site.
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DISADVANTAGES
Limited reach is the only disadvantage of this
flap.
atherosclerosis, diabetes etc may experience flap faliure due to compromised blood supply. In such cases a delay of 7 to 10 days is preferrable.
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THANK YOU.
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