CPT muscle flap

Aktuelle Preise für Produkte vergleichen! Heute bestellen, versandkostenfrei Axial flap CPT Codes. Muscle, myocutaneous, or fasciocutaneous flap; trunk (15734) Muscle, myocutaneous, or fasciocutaneous flap; upper extremity (15736) Muscle, myocutaneous, or fasciocutaneous flap; lower extremity (15738) Flap; island pedicle (15740) Flap; neurovascular pedicle (15750) American. Society. for Codes 15732-15738 are described by donor site of the muscle, myocutaneous, or fasciocutaneous flap. o A repair of a donor site requiring a skin graft or local flaps is considered an additional separate procedure. o (For microvascular flaps, see 15756-15758) o (For flaps without inclusion of a vascular pedicle, see 15570-15576 Microvascular and Free Flaps. Muscle or myocutaneous free flap (microvascular transfer) (15756) Free skin flap (microvascular transfer) (15757) Free fascia flap (microvascular transfer) (15758) Bone graft with microvascular anastomosis; fibula (20955) Bone graft with microvascular anastomosis; metatarsal (20956 To start, CPT changed the official coding instructions to read, The regions listed refer to a donor site when a tube is formed for later transfer or when a delay of flap occurs prior to transfer. Codes 15733-15738 are described by donor site of the muscle, myocutaneous or fasciocutaneous flap

Muscle -75% - Muscle im Angebot

For clarity, code 15734 represents a musculofascial flap involving the mobilization of the rectus muscle whether performed with anterior or posterior release. Code 15734 can only be reported once for each side. It cannot be reported four times—once for each posterior and anterior side. Only one muscle flap is mobilized on each side Random Island Flap: An adjacent tissue transfer technique that involves creation of a flap where the skin is divided all the way around the flap (the incisions completely surround the flap much like water completely surrounds an island which is where this technique gets its name). This island flap receives its blood supply from random non. code, 15732,includedwhich muscle, myocutaneous and fasciocutaneous flaps in theheadandneck,wasdiscontinueddueto ahistoryconfusion,of variable usage and frank misusage. Two newcodesnowrepresentcomplex head and neck flap procedures with addi-tional, explicit clarification provided in the CPT manual regarding the coding for othe CPT terms: 15732 - Muscle, myocutaneous, or fasciocutaneous flap; head and neck (eg, temporalis, masseter muscle, sternocleidomastoid, levator scapulae

Current Procedural Terminology (CPT)* coding may be the single most important area for surgical practice muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, flap; trunk 090 23.00 43.56 15734-59 Muscle, myocutaneous, or fasciocutaneous flap; trunk 090 23.00 43.5 The CPT Code 15734 is the code used for Surgery / integumentary system. The general guidance for this code is that it is used for muscle flap wound repair at trunk. Below you will find cost information associated with this procedure based upon the a set of publicly available data which details all doctors who billed Medicare for this code Codes 15733-15738 are described by donor site of the muscle, myocutaneous, or fasciocutaneous flap. A repair of a donor site requiring a skin graft or local flaps is considered an additional separate procedure. For microvascular flaps, see 15756-15758. For flaps without inclusion of a vascular pedicle, see 15570-15576

flap or a fascial flap without overlying skin, the code 20902, that is a bone graft code, would be used in addition to 15756 or 15758, depending upon the tissue that is transferred. The use of a split-thickness skin graft to cover a muscle flap pressure. The planned rhomboid flap was incised as drawn. It was then elevated with the full-thi ckness and subcutaneous fat. The flap was then rotated into the defect and the donor site was closed. The 2.8 cm2 rhomboid flap was inset in layers using 3.0 Monocryl, 4.0 Monocryl, and 5 0 Prolene The patient tolerated the procedure well 28 and 5.0 Midface flap (i.e., zygomaticofacial flap) with preservation of vascular pedicle(s) 15731 . Forehead flap with preservation of vascular pedicle (e.g., axial pattern flap, paramedian forehead flap) 15733 . Muscle, myocutaneous, or fasciocutaneous flap; head and neck with named vascular pedicle (i.e. The muscle flap is then elevated off the chest wall beneath the deep pectoralis major muscle fascia. Care should be taken in controlling the bleeding from the chest wall perforators at the muscular attachments to the chest. Vessel retraction into the chest can lead to hemothorax

Axial flap CPT Codes - Eaton Han

  1. CPT CODING 15732, Muscle, myocutaneous, fasciocutaneous flap; head and neck (eg, temporalis, masseter muscle, sternocleidomastoid, levator scapulae) SUGGESTED READING. Har-Shai Y, Fukuta K, Collares MV, et al. The vascular anatomy of the galeal flap in the interparietal and midline regions. Plast Reconst Surg. 1992;89:64-69
  2. Procedure definition. Adjacent Tissue Transfer and Rearrangement codes include excision of the lesion. These are the codes to be used for Z-Plasty, W-PLasty, V-Y Plasty, rotation flap (Tenzel flap), advancement flap, double pedicle flap. If these procedures are used in trauma cases, such as laceration repair, the surgeon must create the.
  3. Muscle flap advancement often requires muscle relaxation and only general anesthesia will suffice. General anesthesia does require endotracheal intubation. Patients with COPD are at risk for.
  4. Part 5 focuses on the coding of different types of autologous tissue breast reconstruction procedures. There are two ways reconstruction with a tissue flap may be done: pedicle or free flap. Pedicled flap - The flap remains attached at one end to its blood vessels and the rest of the flap is tunneled beneath the skin to the chest site
  5. Figure 39.1 Trapezius flap. Introduction The trapezius muscle, with its unique triangular shape and great length, extends from the occiput down to the 12th thoracic vertebra and consists of descending, transverse, and ascending parts; its complexity renders a systematic description challenging. Since the upper trapezius myocutaneous flap was first published by McCraw et al. and Demergass

The muscle flap may also be harvested attaching to a segment of the costal cartilage or the lateral portion of the anterior cortex of the sternum. When a skin island is included, the former becomes the costomyocutaneous flap and the latter, osteomyocutaneous flap The medial gastrocnemius muscle flap is not usually harvested as a free flap. However, it can be. And in addition microsurgical techniques can greatly enhance the mobility and length of the flap when used locally. Rather than a distant free flap, it can be used as a local free flap The superior portion of the muscle can be taken on a transverse intramuscular branch of the thoracodorsal vessels: this flap is called the partial superior latissimus flap. The subscapular artery can be from 2 to 5 millimeters in size, while the thoracodorsal artery ranges from 1 to 3 millimeters. The venae commitans is usually slightly larger

The procedure involves elevating a skin flap over the pretarsal part of the orbicularis muscle followed by a skin-muscle flap at the preseptal part of the orbicularis muscle. This technique permits easy access to orbital fat pads while leaving the pretarsal orbicularis muscle intact and, in turn, facilitates the lateral suspension of the. The CPT Code 15732 is the code used for Surgery / integumentary system. The general guidance for this code is that it is used for muscle flap wound repair at head and neck. Below you will find cost information associated with this procedure based upon the a set of publicly available data which details all doctors who billed Medicare for this code 15956 - CPT® Code in category: Excision, trochanteric pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure. CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more As with all sections, the CPT codes regarding deep tissue and skin flaps received a bit of a makeover for the new year. To start, CPT changed the official coding instructions to read, The regions listed refer to a donor site when a tube is formed for later transfer or when a delay of flap occurs prior to transfer. Codes 15733-15738 are described by donor site of the muscle. Pedicled muscle, myocutaneous, or fasciocutaneous flaps are reported with the 1573X series, based upon the donor site of the free flap. Thus, a latissimus dorsi flap to the upper extremity is reported with code 15734. Free muscle flaps are reported with code 15756. A rectus abdominis free flap to the lower extremity is reported with code 15756

CPT code 15734, 15732, 15740 - Muscle, mycoutaneos

  1. Muscle Flap/Free Flap 15734, 15756, 15757 INTEGUMENT Repairs, Adjacent tissue transfers, Skin grafts 12001 - 15431 Flaps including local regional and free 15570 - 15776 Burns 16000 - 16036 Destruction of lesions Laser, dermabrasion, cryotherapy electrocutery 17000 - 17286 17340 - 17999 COSMETIC SURGER
  2. The new and revised 2018 CPT codes for otolaryngology services finalized through the review process of the American Medical Association's (AMA) CPT Editorial Panel and the AMA RVS Update Committee (RUC) are as follows: 15732-15738 Muscle Flap Family (up from 3 codes to 5 codes) 15734 Muscle, myocutaneous, or fasciocutaneous flap; trun
  3. ant vascular pedicle. If a type I muscle can be used as a flap withou

The coding advice may or may not be outdated. Sartorius Flap. Date: Nov 7, 2018. Question: Patient had a thrombectomy and revision of aorto-bi-femoral graft. After patch angioplasty the patient had exposure of graft, and physician did a sartorius muscle flap to cover the graft. Would this be coded as 14021 or 15738? See op note regarding this. ray resection with traditional flap failure/insufficiency so you performed a birotational flap . CPT 28810 Amputation, metatarsal, including toe, single . and . CPT 14040 Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sqcm or less . 32 . 33 CPT ® Code Set. 15733 - CPT® Code in category: Muscle, myocutaneous, or fasciocutaneous flap. CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. CPT code information is copyright by the AMA. Access to this feature is available in the following products

The gastrocnemius is a broad. muscle with a single proximal vascular pedicle, which is well protected. in the popliteal fossa. The gastrocnemius muscle or myocutaneous. rotational flap is used for the procedure of choice for soft-tissue. coverage of complex open wounds about the knee and proximal third of Coding 23395 for Pectoralis Muscle Repair. December 3, 2020. Question: Someone told us to bill 23395 for repairing the pectoralis muscle after removing breast implants. Here's the common scenario: Removal of old bilateral breast implants with capsulectomies. Repair of pectoralis muscle with re-attachment to chest wall A split thickness skin graft to cover a muscle flap is reported with codes 15120 and 15121, based upon the size of the skin graft. The primary ablative procedures are coded separately, in addition to the free flap codes. For a list of all articles with CPT coding visit the CPT Coding Collection on the Residents' Gateway Homepage. REFERENCE In this age of microsurgery and perforator flaps, the temporalis muscle flap still has many useful applications for craniofacial reconstruction. Methods: Three hundred sixty-six temporalis muscle flaps were performed in a single center between 1978 and 2012. The authors divided the cases into two series-before and after 1994-because, after 1994.

The choice of local regional flap is based on the size of the defect, arc of rotation of the flap and surgeon's preference. It has the advantage of being a regional tissue option with a healthy blood supply. The temporalis muscle flap provides a bulky vascular tissue reconstruction The primary indication for the use of the soleus muscle flap is coverage of soft tissue defects in the middle third of the leg. Distal third defects have historically been covered with a free flap; however for small defects and in patients with significant comorbid disease, which would prohibit prolonged anesthesia times, a reverse soleus muscle flap may be considered as an alternative to free.

Gastrocnemius Muscle Flap Description of the Procedure. The gastrocnemius muscle flap with skin graft is a reliable method of reconstruction for the knee. 50 Although the gastrocnemius can carry a skin paddle, the donor-site defect created is undesirable Flaps may be of soft tissue, skin, muscle, bone, fat or fascia. Flaps used for plastic surgery have their own blood supply, that is, their own artery and vein . In this respect, they differ from. A myocutaneous flap is a type of autologous graft, consisting of tissue taken from a patient and used on that patient's own body. As the name implies, this graft includes skin and muscle. Myocutaneous flaps can be used in a wide variety of surgical procedures by people like plastic surgeons and burn specialists

Live Surgery: Vertical Rectus Abdominis Muscle Flap (VRAM

Intrathoracic muscle transposition is a versatile and easily mastered procedure, applicable to a variety of clinical situations. The use of a muscle flap to buttress an esophageal or bronchial closure can minimize postoperative morbidity, particularly in the difficult or complex case Temporalis Muscle Flap

Microvascular and Free Flaps - Eaton Han

Examples include Cutaneous flaps (involving only the skin), Fascia flap (involving only the fascia), muscle flap (involving only the muscles). Composite: this has more than one type of tissue component. Examples include musculocutaneous flaps (combining muscle and skin tissue), osteo-cutaneous (combining bones and skin), or fascio-cutaneous. Unlike ICD-9-CM, the ICD-10-PCS procedure code specifies the deepest layer of tissue involved and site of the advancement flap. Root Operation S: Reposition The definition for the root operation Reposition provided in the 2014 ICD-10-PCS Reference Manual is, Moving to its normal location or other suitable location all or a portion of a body part • The IGAP flap (inferior gluteal artery perforator) uses this blood vesse lto transfe r a section of skin and fat from the bottom of the buttocks, near the buttock crease to reconstruct the breast. Latissimus Dors (iLD) Flap: In a latissimus dorsi flap procedure, an ova lflap of skin, fat, muscle, and blood vessels from t he upper back is.

2018 Flaps Coding Updates - Medical Management Institute (MMI

A gracilis muscle free flap procedure is a highly specialized surgery in which a small portion of a patient's inner thigh muscle is transplanted into the face. Along with the muscle itself, a gracilis free flap procedure involves transplanting the associated blood supply and nerve into a patient's face The latissimus dorsi flap breast reconstruction is a procedure that uses skin, fat, and muscle from the upper back (the flap) to rebuild the breast shape after a mastectomy.Though some tissue flaps are used by themselves to reconstruct the breast, the latissimus dorsi flap is often used in conjunction with a breast implant.The procedure gets its name from the latissimus dorsi, the large. Skin graft and flap surgeries are two procedures that involve relocating a portion of a patient's tissue to another area of the body, to either help a wound heal or cover a scar. The difference between skin grafts and skin flaps is that the latter removes tissue—skin, muscle and/or bone—from the donor site with its original blood supply. Island flap (Fig 18 F): This flap consists of a free island of skin and muscle, where the flap is freed from all sides, but remains attached to a central subcutaneous pedicle; and then advanced in any direction to fill in the defect The paraspinous muscle flap is an excellent choice for wound reconstruction following spine surgery for a variety of reasons: it is anatomical, mirroring the long and narrow geometry of most spinal wounds; it is bipedicled and therefore highly vascular; there is a short operative time required; and there is no need for an additional donor site.

The cut end of the sural nerve was freshened. I utilized the tibialis anterior free muscle flap for creation of a regenerative peripheral nerve interface. The free muscle flap was approximately 3 cm in length by 1 cm wide x 0.5 cm thick. I utilized a 6-0 nylon suture to tack the tibialis anterior free muscle flap to the epineurium of the sural. The paraspinal advancement flap can provide muscle coverage for midline posterior defects. The procedure is performed under general anesthesia in the prone position. It is critical to ensure adequate debridement of any devitalized or necrotic tissue. The paraspinal muscles are located by incising the thoracolumbar fascia medially The latissimus flap uses skin, fat and muscle from the back to create a new breast. The flap is tunneled under the skin and into the chest to create a new breast. Many patients also require a tissue expander or fat grafting for additional volume. The procedure leaves a scar on the mid-back region below the shoulder blade Lower extremity defects can occur due to many reasons, such as a tumor, gunshot wound, and traffic accident. Many different methods have been described in the reconstruction of the lower extremity defects. Muscle flaps are especially useful in upper leg and knee defects. In this study, we presented the medial gastrocnemius flap and PRP(Platelet-Rich-Plasma) application to the 30 years old. The gracilis is a commonly used muscle to create a flap for free tissue transfer or flap surgery for reconstruction of small- to medium-sized soft tissue defects in the arms, legs, head and neck. It is a muscular flap, which means only muscle is used

Documentation Requrements for Myocutaneous/Fasciocutaneous

Wider flaps need skin grafting of the donor area, though preexpansion or the use of local flaps has been advocated to allow for primary closure. 22, 23. Dissecting the flap on top of the muscle fascia (Fig. 2A) makes it thinner and more pliable and avoids muscle herniation; identification of the perforators is slightly more troublesome though. About the Procedure. If you have a mastectomy to treat or prevent cancer, breast reconstruction can surgically recreate a natural-looking breast. One option for breast reconstruction is a transverse rectus abdominus myocutaneous (TRAM) flap procedure. In a TRAM flap, the surgeon first removes muscle, fat and skin from the lower abdomen

Temporalis Muscle Flap and Temporoparietal Fascia Flap

*Pec Flap: 15734 *TPFF, or temporalis muscle flap, or . SCM rotational flap: (all have same code) 15732 *Cervico-facial rotational/advancement flap: if <10 cm2: 14060 . if 10-30 cm2: 14061 . if > 30cm2: 14300 *Paramedian forehead flap: 15731 *Takedown of paramedian forehead flap . pedicle (2 nd stage) 15630 . If you scrub in only to close The ICD-10-CM Alphabetical Index is designed to allow medical coders to look up various medical terms and connect them with the appropriate ICD codes. There are 1 terms under the parent term 'Muscle Or Muscle Flap' in the ICD-10-CM Alphabetical Index . Muscle Or Muscle Flap - see also condition. carnitine (palmityltransferase) deficiency E71.314 Therefore, as per the ICD-10-AM Alphabetic Index code T84.7 Infection and inflammatory reaction due to other internal orthopaedic prosthetic devices, implants and grafts is to be assigned for infection of muscle or myocutaneous flap. Complication. - graft (bypass) (patch) (see also Complication (s)/by site and type) - - muscle Descriptions of CPT codes for mastectomy and breast reconstruction CPT Code Number Description Mastectomy pectoralis minor muscle, but excluding pectoralis major muscle 19301 Mastectomy, partial (e.g., lumpectomy, 19364 Breast reconstruction with free flap 65114 Exenteration of orbit (does not include skin graft), removal of orbital contents; with muscle or myocutaneous flap . 67400 Orbitotomy without bone flap (frontal or transconjunctival approach); for exploration, with or without biopsy . 67405 Orbitotomy without bone flap (frontal or transconjunctival approach); with drainage onl

Muscle Transfer Coding with DIEP Flap - KarenZupko

CPT code 15734, 15732, 15740 - Muscle, mycoutaneos procedure. Congenital Anomaly: A physical developmental defect that is present at the time of birth, and that is identified within the first twelve months of birth. Cosmetic Surgery: Defined by the American Society of Plastic Surgeons, is performed to reshape normal structures of the body in. Coding Excisions. An excision is the surgical removal or resection of a diseased part by an incision through the dermal layer of the skin, and may be performed on either benign or malignant skin lesions. § Intermediate - A layered closure of one or more of the deeper layers of subcutaneous tissue and (non-muscle) Tissue flaps are.

2018 CPT coding changes The Bulleti

THE TEMPORALIS MUSCLE FLAP Johan Fagan The temporalis muscle flap comprises the temporalis muscle, with or without the overlying temporalis fascia. It is an axial flap based on the anterior and posterior deep temporal arteries. The temporoparietal fascial flap, on th Wound debridement codes. 11042—11047 Use these codes when the only procedure performed in wound debridement. Use these codes for foot ulcers, vascular ulcers. 11042 - Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less. + 11045 - each additional 20 sq cm, or part thereof (List separately. 41110 Excision of lesion of tongue without closure. 41112 Excision of lesion of tongue with closure; anterior two-thirds. 41113 Posterior one-third. 41114 With local tongue flap. (List 41114 in addition to code 41112 or 41113) 41115 Excision of lingual frenum (frenectomy) 41116 Excision, lesion of floor of mouth RECTUS MUSCLE FLAP TRANSFER CODES: 15734 -Muscle Flap; Trunk 15734 -59 49561 ‐Repair Incisional hernia; incarcerated 49568 ‐Insertion of mesh RATIONALE: This was coded as an incarcerated incisional hernia with insertion of mesh. This patient also had to have a bilateral muscle flap According to Current Procedural Terminology (CPT), the correct code is 19364, which is breast reconstruction with free flap. This code does not distinguish between the type of flap that is used, nor does it distinguish among free TRAM flaps, muscle-sparing TRAM flaps, DIEP flaps, superficial inferior epigastric artery (SIEA) flaps, and so on

Medical Coding Tissue Transfer or Rearrangement - AAPC

A flap is a piece of tissue that is still attached to the body by a major artery and vein or at its base. This piece of tissue with its attached blood supply is used in reconstructive surgery by being set into a recipient site (injured area onto which a flap or graft is placed). Sometimes, the flap is comprised of skin and fatty tissue only, but a flap may also include muscle from the donor. The Trapezius Myocutaneous Flap Jarl T. Wathne, MD, CPT, MC, USAF* Carl A. Patow, MD, MAJ, MC, USA** Introduction Early pioneers in reeonstruetive surgery, including Zovickian' and Mutter,' ereated skin flaps from the poste­ rior neek and shoulder overlying the trapezius muscle. These skin flaps, however, often required delayed proce Muscle Flap Surgery. A mastectomy is a necessary, yet often times traumatic, surgery that removes one or both breasts of a woman who has cancerous tumors. The intent of the procedure is to prevent the cancer from spreading to lymph nodes and other organs of the body. Although having a mastectomy can be life-saving, it also leaves a woman with.

Latissimus dorsi flap for reconstruction in head and neckQuadruple-component superficial circumflex iliac artery55 Ischial-Bearing Above-Knee Amputation (MidthighBack Reconstruction: History of the Procedure

Hernia repair and complex abdominal wall reconstruction

Conclusions Vascular variations in the trapezius muscle flap are uncommon in Asians, but when present, such variations appear to have little impact on harvesting the flap or on its circulation. The trapezius muscle flap is a viable alternative for posterior neck and scalp reconstruction. Keywords Superficial back muscles / Surgical flap / Cadave The area of advancement is 15 × 4 cm. Which of the following is the most appropriate Current Procedural Terminology (CPT) coding for this procedure? A) 14001 (Advancement flap, 10 to 30 cm2) B) 15734 (Muscle, myocutaneous or fasciocutaneous flap; trunk) and 14301 (advancement flap, 30 to 60 cm2) C) 19380 (Revision of reconstructed breast In our study, muscle flap reconstruction guaranteed better early and late-term results as shown by lower rates of mortality, procedure failure and hemisternum stability. Moreover, Group 1 patients had greater postoperative VC, lower NYHA class and better quality of life The elbow joint is covered by a thin, elastic, soft tissue envelope. This envelope can be compromised after septic olecranon bursitis, injury, tumor resection, or a failed extensor origin release. 1 A number of soft tissue procedures to cover the elbow region have been described. These procedures range from random cutaneous flaps to pedicle muscle flaps, such as the brachioradialis, the flexor.

Neuritis: Fat Pad and Palmaris Brevis Flaps for RecurrentQuadriceps and Patellar Tendon DisruptionThe In&#39;s and Out&#39;s of Coding with Modifiers

The FCU muscle flap, including 2-4 cm of muscle belly, receives a blood supply from a branch of the ulnar artery in the proximal third of the forearm . FCU muscle flaps may be rotated to cover defects on the tip of the olecranon [7, 8]; however, few instances of this procedure have been reported. We recommend a FCU muscle flap for the. Valid for Submission. 0KXG4Z9 is a billable procedure code used to specify the performance of transfer left trunk muscle, gluteal artery perforator flap, percutaneous endoscopic approach. The code is valid for the year 2021 for the submission of HIPAA-covered transactions. The procedure code 0KXG4Z9 is in the medical and surgical section and is part of the muscles body system, classified under. The rule concerning coding pressure ulcers in ICD-10-CM following a skin or muscle flap has left many of us scrambling for answers. We all know that a pressure ulcers treated with a skin or muscle graft/flap are considered surgical wounds for both coding and OASIS, but what do you do when these flaps/grafts fail The rhomboid flap is a local transposition flap - a flap that moves laterally about a pivot point into an adjacent defect. This lateral movement differs it from a rotation flap. The donor site wound is closed directly under minimal tension. Other examples of transposition flaps include: Bilobed Flap. Z-plasty 67343 Release, extensive scar tissue w/o detaching extraocular muscle 67345 Chemodenervation, extraocular muscle 67346 Biopsy, extraocular muscle 67399 Unlisted procedure, ocular muscle 67400 - 67599 Orbit 67400 Orbitotomy w/o bone flap; for exploration 67405 Orbitotomy w/o bone flap; w/ drainage onl The latissimus dorsi myocutaneous flap (LDMF) is one of the most reliable and versatile flaps used in reconstructive surgery. [1, 2] It is known for its use in chest wall and postmastectomy reconstruction and has also been used effectively for coverage of large soft tissue defects in the head and neck, either as a pedicled flap or as a microvascular free flap