Modified Approach to the Cervicofacial Rotation Flap in Head and Neck Reconstruction

Objectives: Large cutaneous defects of the cheek and external ear present a reconstructive challenge. While free tissue transfer has been increasingly used for such defects, many patients with these malignancies are poor candidates for lengthy reconstructive surgery. The cervicofacial and cervicothoracic advancement flaps have been previously described as a simple method for reconstructing defects of the face and neck. However, for large facial defects, these flaps typically require wide undermining with the final closure sometimes under tension. We describe our experience utilizing a modified approach to the cervicofacial rotation flap which has little tension of the defect closure and avoids incisions or undermining of tissue inferior to the clavicle. Study Design: Retrospective chart review. Methods: Sixteen patients underwent a modified cervicofacial rotation flap for immediate reconstruction of a cheek and/or total auriculectomy defect. Results: Primary cutaneous malignancies were the most common surgical indication, followed by parotid tumors with overlying skin involvement. Five patients had total auriculectomy defects while 11 patients had defects involving cheek skin without auriculectomy. Defect diameter size varied from 5 to 12 centimeters. Two patients required skin grafting of the donor site. Four patients had minor wound dehiscences that were treated with local wound care and allowed to close by secondary intention. Conclusions: We describe a modified approach to the cervicofacial rotation flap which minimizes undermining to provide a tension-free closure of the defect. Our approach is a simple, reliable method for coverage of large cutaneous defects involving the cheek and external ear.