Free Rectus Muscle Flap to Scalp with Saphenous Vein Graft to External Jugular

Radiation is often a necessary adjuvant in the treatment of many cancers. While radiation is often necessary in cancer therapy, the radiation can also cause damage to normal healthy tissue and prevent wound healing.

When radiation is used on the head, not only can it cause injury to the skin and subcutaneous tissue, it can also cause damage to the underlying bone. When the bone develops osteoradionecrosis, it can often cause wounds to recur or simply become non-healing. When the bone is removed, often a titanium mesh or bone cement is used to cover the brain.

Usually there is not enough tissue on the scalp to close these defects, therefore free tissue transfer and microsurgery is necessary to bring in healthy tissue to the area to close the wounds.

The rectus muscle is a nice muscle to use in this scenario as there is a long pedicle leash and a muscle with a large surface area. Occasionally the superficial temporal artery is of good quality and the vein may be small. In this case we have found that the saphenous vein can be an effective vein graft from the flap to the external jugular. We find that in the past many have not advocated the use of vein grafts. However, often is more advantageous to use a vein graft to a more suitable outflow than to rely on a marginal vein in the vicinity of the wound.

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Latisimus Flap for Closure of Complex Posterior Trunk Radiation Wounds

Radiation is often a necessary adjuvant in the treatment of many cancers. While radiation is often necessary in cancer therapy, the radiation can also cause damage to normal healthy tissue and prevent wound healing.

Closure of the radiated wound is often one of the most challenging problems the Plastic & Reconstructive Surgeon can face. The key to closing radiated wounds is adequate debridement. Often adequate debridement can create a much larger wound that the original and often much larger than anticipated by both patient and surgeon.

After adequate debridement has been performed, the next important step in reconstruction is to make sure that healthy tissue is brought into the area affected to allow wound closure. In some cases, tissue from an adjacent area of the body can be used, occasionally regional tissue may be used, and in some cases distant tissue is used to be brought into the area to allow wound closure. When tissue from a remote area of the body is used, this is called free tissue transfer or microsurgical anastomosis.

In this case a large posterior trunk wound was present after successful cancer removal and successful radiation therapy. The wound was thoroughly debrided to relatively healthy tissue. A wound VAC was then placed on the posterior trunk to promote blood perfusion and as a bridge to determine the final wound size and plan reconstruction.

In this case, a latisimus myocutaneous flap was used to bring both muscle to cover exposed bone and skin to fill a defect. A small skin graft was placed on the latisimus muscle to prevent too tight of a wound closure. The skin graft however contracts over time and can often eventually be excised and the wound closed with one skin paddle.