The deltopectoral flap lifts a broad strip of skin from the upper chest and swings it up to resurface the neck or lower face. Thin and pliable, it remains a valuable rescue option when other reconstructions have failed.
A deltopectoral flap is a strip of upper chest skin raised on perforating vessels beside the breastbone and turned upwards to cover the neck or lower face. Because the skin is thin and supple it resurfaces well, and the technique is often used to rescue a neck wound that has broken down or is leaking saliva.
Skin over the upper chest, running from beside the breastbone out towards the shoulder, is thin, smooth and supple. Those qualities make it a good match for the neck and the lower part of the face, where thick tissue would look and feel wrong. Surgeons raise this strip as a flap based near the midline, where a row of perforating vessels comes through between the ribs to supply it.
Transfer happens in stages. At the first operation the flap is turned upwards and stitched into the neck or face while remaining attached at its base, forming a visible bridge across the collarbone. New vessels grow into the flap from its recipient bed over the following weeks. Once that has happened, a second, shorter operation divides the bridge and returns any spare tissue to the chest.
Free flaps and the chest muscle flap have taken over much of this work. Even so, when a neck wound has broken down after radiotherapy, when saliva is leaking through the skin, or when vessels for microsurgery are unusable, this flap still earns its place. The donor area usually needs a split thickness skin graft to close.
This technique is chosen for thin, broad cover in the neck and lower face, often when other reconstructions are unavailable or have already failed.
The defect is measured and a strip of upper chest skin is marked from beside the breastbone out towards the shoulder. Its base is kept near the midline so the feeding vessels are preserved.
Skin and the layer beneath are lifted from the shoulder end inwards, stopping short of the perforating vessels. Handling the flap gently here protects the circulation along its length.
The strip is turned upwards and sewn into the neck or face defect. A bridge of tissue crosses the collarbone and is dressed so nothing presses on it.
The raw area on the chest is usually resurfaced with a split thickness skin graft taken from the thigh. That graft is held with a dressing for several days.
After a few weeks, once the flap is living off its new bed, a shorter operation divides the bridge. Spare tissue is returned to the chest and the edges are tidied.
Flap colour is checked frequently and drains are monitored. Neck movement is limited so nothing pulls on the bridge, and pain relief is given regularly.
The thigh graft site and the chest graft are reviewed and dressings changed. Sutures start coming out and swelling begins to fall.
The bridge is divided at the second stage. Neck movement is gradually restored with guided exercises once the wounds are secure.
Colour of the transferred skin evens out. The chest graft stays visible, and gentle massage and sun protection help it soften.
Cover is usually achieved and the neck wound settles, which is the main aim. Colour of chest skin on the neck differs somewhat from facial skin and stays noticeable. The donor area carries a grafted patch that remains visible for life. Neck movement improves with exercises, though some tightness can persist. A further small procedure to tidy the flap edges is common.
A long, staged flap carries its own set of problems, and the tip is always the most vulnerable part.
Three areas need attention here, the chest donor site, the neck recipient site, and the thigh where the graft was taken.
Newer methods have replaced it for routine work, yet it remains dependable for salvage when vessels are unusable or a previous repair has failed.
Most donor areas need a split thickness skin graft. That is planned from the start, and the thigh where the graft is taken needs its own care.
Staging is built into the design. The bridge keeps the flap alive until it can survive on blood vessels growing in from its new bed.
It is thin and supple, which suits the neck well, but colour differs from facial skin and the difference usually remains visible.
Elegance Clinic in Surat takes on difficult neck wounds that have already been treated elsewhere, and Dr. Ashutosh Shah explains clearly when a staged flap is the safer route than another attempt at microsurgery.
Technique pages do not carry their own price, because this flap is a way of covering a wound rather than a treatment on its own. What you pay depends on the condition being treated, the number of stages, grafting of the donor area, anaesthesia and the length of hospital stay.
Bands for the underlying treatments sit on their own pages, and a written estimate is prepared after examination so the family knows the figure before admission.
These are the questions that come up most often in consultation. If yours is not here, send it on WhatsApp and the team will reply, usually the same day.
Ask your question →A technique carries no separate price. Cost follows the treatment it is used within, the number of stages, whether the donor area needs a graft, anaesthesia and hospital stay. A written estimate is prepared once you have been examined.
It has a long track record and a dependable blood supply. The recognised risks are loss of the far end of the flap, graft failure on the chest, infection and a continuing leak. Smoking raises each of these noticeably.
The bridge stays in place for a few weeks before a second, shorter operation divides it. Wounds are usually settled by around six weeks, and neck movement improves with exercises over the months that follow.
A broad scar runs across the upper chest, and much of it is a grafted patch that differs in colour and texture. Clothing covers it in most cases. The patch softens and pales slowly.
People whose chest wall has been irradiated or previously operated on may have damaged feeding vessels. Deep cavities needing bulk, continued smoking, and being unable to return for a second stage all point elsewhere.
Usually when neck vessels are scarred or irradiated, when general health rules out a long microsurgical operation, or when an earlier reconstruction has failed and a dependable rescue is needed quickly.
Previous surgery, radiotherapy and current wound problems are reviewed, and the chest is examined for scars. Both stages are explained, donor site grafting is described, and photographs are taken before a plan is agreed.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
