Beauty of skin-grafted free muscle flaps in head and neck reconstruction

In the era of perforator flaps, muscle flaps might seem "out of fashion" for use in microvascular reconstructions. In this presentation, the advantages of pure muscle flaps covered with full-thickness (FTSG) or split-thickness (STSG) skin grafts employed in certain head and neck reconstructions shall be demonstrated. The free vastus lateralis muscle flap (n = 13) and latissimus dorsi flap (n = 1), covered with either FTSG (n = 8) or STSG (n = 6), were used for major head and neck reconstructions in a total of 13 patients. There was no revision, no partial flap necrosis, and no flap loss. All skin grafts healed in. After initial swelling, all flaps developed an adequate form according to the respective skin level, with adequate texture and color match. This was especially the case when FTSG was used. No cosmetic corrections were necessary. Donor-site morbidity was negligible. In conclusion, a free muscle flap covered with FTSG is a safe and fast reconstruction that provides good cosmetic and functional results, combined with negligible donor-site morbidity.