Pedicled Myocutaneous Trapezius Flap Reconstruction for Scalp and Back Defects: Our Experience of Management

Background: Posterior scalp defects are trivial defects to reconstruct due to the location, defect size, exposed calvaria/implants, and lack of local tissue. They are also pressure-bearing areas. These require optimal reconstruction for adequate postoperative functional outcomes with less complications. Materials and Methods: Here, we collected data of our operated patients (four patients) involving posterior scalp and neck defects of varying etiologies like acne keloidalis nuchae, dermatofibrosarcoma, postoperative implant exposure, and trichilemmal carcinoma, all of which were managed using a pedicled lower trapezius myocutaneous flap. The details of the patient, procedure, and outcome were tabularised in the results section. Results: All patients underwent optimal coverage of defects with trapezius myocutaneous flap reconstruction. Three patients had uneventful recoveries, and one developed wound infection and dehiscence, which was effectively managed with negative pressure wound therapy and secondary suturing. No major flap-related complications or functional deficits in the trapezius muscle were noted. Patients remained asymptomatic and satisfied during follow-up periods of up to 2 years. Conclusion: Despite advancement of microsurgical techniques and ease of performing microsurgery, the lower trapezius myocutaneous flap has its merits as a suitable alternative to free tissue transfer for coverage of posterior scalp and neck defects.