Extensive cervicofacial defects often lead to functional and aesthetic impairments. The pre-expanded cervico-acromial flap technique is reliable and cost-effective for addressing such defects.

To introduce our 34 years’ experience on pre-expanded cervico-acromial flap technique, emphasizing key surgical techniques.

The supraclavicular artery and its main branches were evaluated with Doppler ultrasound preoperatively. Pre-expansion was performed in most cases to optimize flap dimensions, with the tissue expander placed at the subfascial level to preserve adequate blood supply. Once fully expanded, the cervico-acromial flap was raised and rotated to cover the cervicofacial defects. The pedicle was divided three weeks postoperatively.

A total of 19 patients (5–57 years) were finally included in this retrospective study. They all accepted the above-mentioned technique by the same senior surgeon from October 1990 to October 2024. The expanded flap sizes ranged from 15 × 7 cm to 35 × 15 cm. The follow-up lasted from 6 months to 9 years. All flaps survived without necrosis or infection. Patients expressed high satisfaction with functional and cosmetic outcomes in both donor and recipient areas.

The pre-expanded cervico-acromial flap is safe and effective for repairing the extensive cervicofacial defects. Thorough understanding of this flap's blood supply and careful design based on the vascular anatomy help to improve the flap's survival rate.