Head and Neck Reconstruction: Local Flaps

Operative treatment of head and neck cancers can result in impairment of swallowing, speech, respiration and appearance. Alongside control of the disease, rehabilitation is an essential goal of treatment. Reconstruction, often in the form of flap surgery, aims to restore form and function for rehabilitation.

Flap surgery refers to the transfer of tissue, with its blood supply, from a healthy part of the body (donor site) to the defect (recipient site). Flaps can be categorised into local, regional and free flaps.

LOCAL FLAPS

Local flaps are harvested from tissue adjacent to the defect. Local flaps are favoured in the head and neck when compared to distant flaps due to its excellent colour and texture match. They are commonly used for closure after resection of small skin cancers. Examples of local flaps include the nasolabial and rhomboid flap.

1) Nasolabial Flap

The nasolabial flap utilises skin laxity around the nasolabial fold to close nasal, perioral and intraoral defects, with the option of performing a bilateral procedure for larger defects.

The flap can be harvested as a random pattern flap or an axial flap based on perforators from the facial and angular arteries, and can be used as a one-stage or twostage flap.

For the two-stage procedure, the flap is divided 2 to 4 weeks after the initial surgery and appropriately thinned and contoured. The nasolabial flap provides good aesthetic outcomes, and a low incidence of post-operative trismus due to the proximity of the donor site.

2) Rhomboid (Limberg) Flap

Rhomboid flaps are transposition flaps that are rotated about a pivot point. They are designed with 60- and 120- degree angles, and the longitudinal axis of the rhomboid parallels the line of minimal skin tension. This technique can be expanded to create a double or triple rhomboid flap. The donor site of the flap can be closed by direct sutures.