The pectoralis major is a large fan-shaped muscle that covers most of front of the chest. The muscle has got the advantages of richness in vascularity, availability of large cutaneous surface, direct transfer without delay, wide arc of rotation, large muscular bulk, ability to close the donor site directly, and can be harvested with ease. These qualities make it nearly ideal axial flap for head and neck reconstruction.
The pedicle of the deltopectoral flap is at the sternum. The flap is supplied by the first three perforating branches of the internal thoracic (internal mammary) artery. The flap is useful for reconstruction of the tongue, floor of the mouth, tonsil, pharynx, neck, and cheek. It is done as one- or two-stage procedure.
The palatal island mucoperiosteal flap is a well-vascularized flap supplied by greater palatine artery. The exposed palatal bone heals by secondary intention without any functional contraction or functional morbidity. The flap is rotated to retromolar trigone, tonsil, and lateral pharyngeal wall with excellent result.
Platysma myocutaneous flap is one of the options for reconstruction of intraoral and pharyngeal defect. This flap derives its arterial supply from the submental branch of facial artery. The flap thickness closely matches the thickness of the mucosa of the oral cavity.
Facial artery musculomucosal flap can be based superiorly or inferiorly. The width and length of the flap varies between 1.5 and 2.0 cm and 8 and 9 cm, respectively. The donor area is closed in two layers. The flap is very useful to cover moderate size defects of the alveolus floor of the mouth cheek, lip, palate, and tongue.
The temporoparietal fascia is the most superficial fascial layer beneath the subcutaneous fat in the temporal region and is continuous with the superficial musculoaponeurotic system inferiorly. This fascia is a broad, well-vascularized flap that can be harvested rapidly and safely. Because of its proximity to the cheek, orbit, and ear, it is often used for reconstruction of these sites.
Nasolabial flaps can be superior or inferior based. They are used for local reconstruction of moderate defects of the anterior oronasal structures.
Calvarial bone grafts are used in craniomaxillofacial reconstruction. Greatest degree of bone survival is achieved by transfer of vascularized bone. Calvarial bone based on a muscle-fascial-periosteal pedicle supplied by superficial temporal artery is ideal for this procedure.
The submental artery island flap is a reliable source of skin of excellent color and texture for facial area. The flap is safe, rapid, and simple to raise. The scar of the donor site is also hidden.
The latissimus dorsi myocutaneous flap is able to provide skin, subcutaneous tissue, muscle, bone, nerve, and vascular pedicle. Large skin surface is capable of covering massive defects. The flap is also capable of reaching to the superior location of the head.