The main disadvantage to using the latissimus flap is the risk of vascular compression and flap loss. The vascular pedicle is subject to compression as it passes under the axilla. The patient must be placed in a lateral decubitus position to harvest the flap and the access incision along the axillary fold is lengthy. The donor site has a propensity to form seromas often requiring prolonged (> 1 week) placement of suction drains. Brachial plexus shearing or stretch injury may occur if precautions are not taken including head flexion and shoulder/axilla support during flap harvest. |

Loss of the latissimus muscle results in little functional morbidity except in those patients who require the specific actions provided by this muscle including wheelchair users, swimmers, or construction workers.

Sternocleidomastoid '5

Description o

The sternocleidomastoid flap is a type IV musculocutaneous flap that been used in reconstructing oral and cheek defects since 1955 (1). The muscle extends from an @

Figure 2 Pedicled latissimus musculocutaneous flap showing large expanse of muscle with a central skin island.

inferomedial attachment to the clavicle and sternum to a superolateral attachment to the mastoid process. The muscle is usually pedicled superiorly for oral defects, taking advantage of its superiorly oriented blood supply.

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