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Use of the Teres Major Muscle in Chimeric Subscapular System Free Flaps for Head and Neck Reconstruction
Andrew R Tomlinson1, Mark J Jameson2, Nitin A Pagedar3
1Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico Health Science Center, Albuquerque.
Importance:
We present what we believe to be the first case series in which the teres major muscle is used as a free flap in head and neck reconstruction.
Objectives:
To describe our experience with the teres major muscle in free flap reconstruction of head and neck defects and to identify advantages of this approach.
Design, Setting, And Participants:
A retrospective review was performed at 2 tertiary care centers between February 1, 2007, and June 30, 2012. Data analysis was conducted from July 31, 2014, through December 1, 2014.
Intervention:
Teres major muscle free flap for use in head and neck reconstruction.
Main Outcomes And Measures:
Indications for use, complications, and outcomes including donor site morbidity.
Results:
The teres major free flap was used in 11 patients as a component of chimeric subscapular system free flaps for a variety of complex head and neck defects. The teres major muscle was used to fill soft-tissue defects of the neck, face, and nasal cavity; it provided substantial soft-tissue volume but was less bulky than the latissimus dorsi muscle. The teres major muscle was also used to provide protection for vascular anastomoses and/or great vessels and to enhance soft-tissue coverage of the mandibular reconstruction plate. In addition, the muscle was selected as a substrate for skin grafting where inadequate neck skin remained. Flap survival occurred in 10 of 11 flaps (91%). Two flaps (18%) demonstrated venous congestion that was managed successfully. Two patients (18%) developed minor recipient-site complications (submental fistula and infection with recurrent wound dehiscence and plate exposure). All donor sites healed well, with chronic, mild shoulder pain noted in 2 patients (18%) and no postoperative seromas observed in any patient.
Conclusions And Relevance:
Addition of the teres major muscle to a subscapular system free flap is an option for reconstruction of a variety of complex head and neck defects, particularly when a moderate amount of soft tissue is required. In select cases, the teres major muscle may have advantages over the latissimus dorsi muscle.
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