Management of deltopectoral flap failure using a three-stage revision reconstruction: a case report

Although deltopectoral flap failure is uncommon, its management can be difficult. This report presents a case of deltopectoral flap failure successfully rescued by a three-stage revision reconstruction using the postdebridement flap. A 59-year-old patient presented with a pharyngocutaneous fistula due to radionecrosis and subsequently underwent a medially based deltopectoral flap reconstruction for fistula closure. Unfortunately, this operation was unsuccessful because the flap developed necrosis at its distal tip, and the postdebridement flap could not be directly placed on the defect because of its shorter length. A subsequent revision operation successfully closed the fistula using a three-stage reconstruction with the postdebridement flap. Although this three-stage technique can avoid the morbidity associated with additional flap harvesting and can greatly extend the distance to the recipient, it also requires more time to heal and more operations than simply harvesting a new flap.