The pear-shaped modification of the lower trapezius flap

A series of six patients is presented to demonstrate the pear-shaped modification of the lower trapezius musculocutaneous pedicled island flap. Five patients underwent reconstruction of defects following extended temporal bone and skull base resection, and one following excision of a radionecrotic ulcer over the scapular spine. All flaps survived completely; there was one minor complication of a donor site seroma. This flap is useful for reconstruction up to the level of the ear and has an excellent are of rotation. The advantages of the pear-shaped modification are a decrease in the skin tension at the point of closure over the vascular pedicle, and an increase in the contact area between the skin paddle and underlying muscle.