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The horizontal infrahyoid musculocutaneous flap in head and neck reconstruction
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British Journal of Oral and Maxillofacial Surgery 47 (2009) 76–77
Technical note
The horizontal infrahyoid musculocutaneous flap in head and neck reconstruction A.S. Ricard ∗ , M. Laurentjoye, F. Siberchicot, C. Majoufre-Lefebvre Departments of Maxillofacial and Plastic Surgery, Centre Hospitalier Universitaire de Bordeaux 33076 cedex France Accepted 25 June 2008 Available online 4 September 2008
Keywords: Infrahyoid musculocutaneous cutaneous flap; Head and Neck; Cancer
In 1986, Wang first described the Infrahyoid musculocutaneous flap for head and neck reconstruction.1 In spite of its limited rotation arch, this flap has proven to be helpful in the reconstruction of a wide range of moderate-sized head and neck defects.1–5 The pedicle of this flap is based on the superior thyroid vessels. To increase success rate, some authors described modifications of the original technique.5 Since March 1997, we have changed our cervical incision in order to improve the aspect of the final scar. The design of the incision evolved from vertical to horizontal. The infrahyoid muscles are used for this flap, including the sternohyoid, sternothyroid and the omohyoid. This flap is completed by the platysma and the overlying skin. The superior portion is vascularised by the superior thyroid artery and its branches and the inferior third by the inferior thyroid artery. Venous drainage takes place through the inferior thyroid vein which drains to the internal jugular vein. After measuring the defect, we outline the horizontal skin paddle at the same neck side of the tumour resection .The design of the skin paddle is on the level of the cricoid. (Fig. 1) The surgical procedure is then as described in publications.1,2 The donor site can be closed primarly without difficulties after the supraomohyoid neck dissection (Fig. 2). The time of dissection is about 60 minutes. A variety of flaps are available for reconstructing surgical defects in the head and neck. First described by Wang in ∗
Corresponding author. E-mail address: [email protected] (A.S. Ricard).
Fig. 1. Modification of the infrahyoid myocutaneous flap: the horizontal design of the skin paddle.
1986,1 the infrahyoid musculocutaneous flap is thin, reliable and lies close to the surgical defect. This musculocutaneous flap can be used in all areas of the upper aerodigestive tract below the line between the tragus and the lip commissural.1,5 A skin paddle up to 6 cm × 10 cm is possible, depending on the laxity of the cervical skin. We use this flap for reconstruction of small and medium sized defects of oral cavity after cancer resection. This flap allows 1-4 neck dissection but not radical neck dissection. A relative contraindication of this flap is the existence of a palpable lymph node in the region of the flap pedicle. The advantages of the Infrahyoid musculocutaneous flap are that it is easy and quick to harvest and there is primary closure of the donor area. The versality of the flap allowed
0266-4356/$ – see front matter © 2008 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2008.06.017
A.S. Ricard et al. / British Journal of Oral and Maxillofacial Surgery 47 (2009) 76–77
Fig. 2. Closure of the donor site.
77
The complication rate reported in the literature is extremely variable ranging from 3% to 47%.1–4 The main problem are related to the reliability of the skin paddle for insufficient veinous drainage. Recently, Dolivet et al described a modification of the original technique to improve drainage and they changed the cervical incision from an inverted T to an inverted Z, with better aesthetic results.5 Since March 1997, we have modified the design of the skin paddle from vertical to horizontal to improve the result of the final scar (Fig. 3). The modification if the design of the skin paddle don’t compromise the reliability of the flap and the horizontal design of the skin paddle allows a scar what is included in the design of the incision of neck dissection. The main surgical contraindications of this flap are a previous thyroid surgery,radical neck dissection,history of head and neck radiotherapy With the horizontal design of the skin paddle, there are less cosmetic sequelae with the same reliability.
References
Fig. 3. The final scar after 6 months.
in most of cases to reconstruct approximately the preoperative anatomy. In case of tongue reconstruction, it is useful to preserve the motor innervation of the infrahyoid muscles provided by ansa cervicalis.3
1. Wang H, Shen JW, Ma DB, Wang JD, Tian AL. The infrahyoid myocutaneous flap for reconstruction after resection of head and neck cancer. Cancer 1986;57:663–8. 2. Majoufre C, Faucher A. The infrahyoid musculocutaneous flap. Anatomic bases and the results of a preliminary experience in cervicofacial oncology. Rev Stomatol Chir Maxillofac 1994;95(4):319– 24. 3. Rojanin S, Suphaphongs N, Ballatyne AJ. The infrahyoid musculocutaneous flap in head and neck reconstruction. Am J Surg 1991;162: 400–3. 4. Remmert SM, Sommer KD, Majocco AM, Weerda HG. The neurovascular infrahyoid flap: a new method for tongue reconstruction. Plast Reconstr Surg 1997;99:613–8. 5. Dolivet G, Gangloff P, Sarini J, ton Van J, Garron X, Guillemein F, Lefebvre JL. Modification of the infrahyoid musculocutaneous flap. Eur Surj Oncol 2005;31:294–8.
British Journal of Oral and Maxillofacial Surgery 47 (2009) 76–77
Technical note
The horizontal infrahyoid musculocutaneous flap in head and neck reconstruction A.S. Ricard ∗ , M. Laurentjoye, F. Siberchicot, C. Majoufre-Lefebvre Departments of Maxillofacial and Plastic Surgery, Centre Hospitalier Universitaire de Bordeaux 33076 cedex France Accepted 25 June 2008 Available online 4 September 2008
Keywords: Infrahyoid musculocutaneous cutaneous flap; Head and Neck; Cancer
In 1986, Wang first described the Infrahyoid musculocutaneous flap for head and neck reconstruction.1 In spite of its limited rotation arch, this flap has proven to be helpful in the reconstruction of a wide range of moderate-sized head and neck defects.1–5 The pedicle of this flap is based on the superior thyroid vessels. To increase success rate, some authors described modifications of the original technique.5 Since March 1997, we have changed our cervical incision in order to improve the aspect of the final scar. The design of the incision evolved from vertical to horizontal. The infrahyoid muscles are used for this flap, including the sternohyoid, sternothyroid and the omohyoid. This flap is completed by the platysma and the overlying skin. The superior portion is vascularised by the superior thyroid artery and its branches and the inferior third by the inferior thyroid artery. Venous drainage takes place through the inferior thyroid vein which drains to the internal jugular vein. After measuring the defect, we outline the horizontal skin paddle at the same neck side of the tumour resection .The design of the skin paddle is on the level of the cricoid. (Fig. 1) The surgical procedure is then as described in publications.1,2 The donor site can be closed primarly without difficulties after the supraomohyoid neck dissection (Fig. 2). The time of dissection is about 60 minutes. A variety of flaps are available for reconstructing surgical defects in the head and neck. First described by Wang in ∗
Corresponding author. E-mail address: [email protected] (A.S. Ricard).
Fig. 1. Modification of the infrahyoid myocutaneous flap: the horizontal design of the skin paddle.
1986,1 the infrahyoid musculocutaneous flap is thin, reliable and lies close to the surgical defect. This musculocutaneous flap can be used in all areas of the upper aerodigestive tract below the line between the tragus and the lip commissural.1,5 A skin paddle up to 6 cm × 10 cm is possible, depending on the laxity of the cervical skin. We use this flap for reconstruction of small and medium sized defects of oral cavity after cancer resection. This flap allows 1-4 neck dissection but not radical neck dissection. A relative contraindication of this flap is the existence of a palpable lymph node in the region of the flap pedicle. The advantages of the Infrahyoid musculocutaneous flap are that it is easy and quick to harvest and there is primary closure of the donor area. The versality of the flap allowed
0266-4356/$ – see front matter © 2008 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2008.06.017
A.S. Ricard et al. / British Journal of Oral and Maxillofacial Surgery 47 (2009) 76–77
Fig. 2. Closure of the donor site.
77
The complication rate reported in the literature is extremely variable ranging from 3% to 47%.1–4 The main problem are related to the reliability of the skin paddle for insufficient veinous drainage. Recently, Dolivet et al described a modification of the original technique to improve drainage and they changed the cervical incision from an inverted T to an inverted Z, with better aesthetic results.5 Since March 1997, we have modified the design of the skin paddle from vertical to horizontal to improve the result of the final scar (Fig. 3). The modification if the design of the skin paddle don’t compromise the reliability of the flap and the horizontal design of the skin paddle allows a scar what is included in the design of the incision of neck dissection. The main surgical contraindications of this flap are a previous thyroid surgery,radical neck dissection,history of head and neck radiotherapy With the horizontal design of the skin paddle, there are less cosmetic sequelae with the same reliability.
References
Fig. 3. The final scar after 6 months.
in most of cases to reconstruct approximately the preoperative anatomy. In case of tongue reconstruction, it is useful to preserve the motor innervation of the infrahyoid muscles provided by ansa cervicalis.3
1. Wang H, Shen JW, Ma DB, Wang JD, Tian AL. The infrahyoid myocutaneous flap for reconstruction after resection of head and neck cancer. Cancer 1986;57:663–8. 2. Majoufre C, Faucher A. The infrahyoid musculocutaneous flap. Anatomic bases and the results of a preliminary experience in cervicofacial oncology. Rev Stomatol Chir Maxillofac 1994;95(4):319– 24. 3. Rojanin S, Suphaphongs N, Ballatyne AJ. The infrahyoid musculocutaneous flap in head and neck reconstruction. Am J Surg 1991;162: 400–3. 4. Remmert SM, Sommer KD, Majocco AM, Weerda HG. The neurovascular infrahyoid flap: a new method for tongue reconstruction. Plast Reconstr Surg 1997;99:613–8. 5. Dolivet G, Gangloff P, Sarini J, ton Van J, Garron X, Guillemein F, Lefebvre JL. Modification of the infrahyoid musculocutaneous flap. Eur Surj Oncol 2005;31:294–8.