Dolivet 2005
Dolivet 2005
Dolivet 2005
www.ejso.com
KEYWORDS Abstract Background. In 1986, Wang described the infra hyoid musculo-cutaneous
Infrahyoid flap. Here, we report technical adaptations and improvements to this flap.
myocutaneous flap; Methods. From 1994 to 1996, we performed 61 infrahyoid flaps using the classical
Head and neck; procedure. After 5 years of technical evolution, we studied a new series of 91 flaps
Cancer; from January 2000 to June 2002. We reviewed our experience with the infra hyoid
Rehabilitation flap and described the surgical procedure, its evolution and the impact on the
fiability of the flap.
Results. In the two series, the main arterial pedicle was usually the superior
thyroid artery. Venous drainage was more variable; consequently we always
performed a modified neck dissection with preservation of the internal jugular
vein. In the first series, the surgical results were good with only seven local
complications essentially skin necrosis. The functional and aesthetic results seemed
acceptable.
In the second series, the results, after technical evolution with better venous
drainage and cervical closure, were improved (only one necrosis) and the indications
were extended.
Conclusion. With experience, the infra hyoid myocutaneous flaps is reliable and
appears as a particularly useful flap for oral cavity, oral pharynx and pharyngeo-
laryngeal reconstruction.
q 2004 Elsevier Ltd. All rights reserved.
0748-7983/$ - see front matter q 2004 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ejso.2004.10.006
Modification of the infra hyoid musculo-cutaneous flap 295
Figure 1 (1) Original incision and closure of the skin (first series). (2) Evolution of the incision with major
improvement of the quality of skin closure (second series).
this series, the mean flap dimensions were 7!4 cm2 Discussion
with a range of 3!2 to 10!5 cm3. The cervical
closure was always performed without any second In our first series, the results in terms of flap
flap necessity. A neck dissection, homolateral to reliability were comparable with those published in
the sampling site was systematically performed, the literature.1–3 The usual respect of contraindica-
with preservation of the internal jugular vein in all tions helped to avoid the complications encoun-
cases. The flap was performed after neck radio- tered by other authors.4 The main surgical contra
therapy in four cases. indications are a previous thyroid surgery, radical
Forty-one patients had cicatrisation without neck dissection or indication of resection on the
complications for the flap or the donor site. Local side of the flap, muscular involvement on the
complications occurred in 10 patients. The majority resection site and/or history of head and neck
of patients (42/61) were able to eat normally. The radiotherapy. The use of this flap in irradiated sites
remaining 19 patients had to adapt their eating was rare in our experience (7%). As reported by
habits by mincing (17/19) or by mixing (2/19) their Magrin,4 and although not confirmed in our experi-
food (Table 1). ence, the success rate for this type of flap decreases
from 90 to 53% in case of prior irradiation. A relative
Second series (2000–2001) contraindication to the flap is the existence of a
Between January 2000 and June 2001, we pro- palpable lymph node in the region of the flap
ceeded 91 infrahyoid flaps with the new surgical pedicle. In our experience, in only one case a
procedure, 15 after neck radiotherapy. Results dissected flap had to be resected because the
were analysed for global survival of flap and pedicle was in close proximity to a metastatic node.
functional result (global and in accordance to the Conversely to Wang,1 the size of the cutaneous
tumoral site or the tumoral stage). flap sampled was always compatible with a direct
The flap survived without any complication in 88 suture of the sampling site. Skin paddle necrosis
cases. There was only one total necrosis in was considered as minor complication because the
irradiated area and two partial necrosis in non- underlying strap muscle was viable. Among the
irradiated area. The global functional result was: cases of skin paddle necrosis with good muscular
good in 62 cases, fair in 23, poor in 6. viability, two flap retractions occurred after radio-
According to the site, the results were, respect- therapy, only in the first series. May be, given the
ively: for oral cavity: 23, 5 and 3 cases; for small diameter of the feeding vessels,6,7 a post-
oropharynx: 20, 14 and 2 cases; for larynx: 10, 2 therapeutic sclerosis could induce the retractile
and 1 case, and for hypopharynx: 9, 2 and 0 case. cicatrisation.
According to the tumoral stage, they were: for The versatility of the flap allowed in most of
T1 (14 cases): 12, 2 and 0 case; for T2 (32 cases): 24, cases to reconstruct approximately the pre-oper-
7 and 1 case; for T3 (23 cases): 20, 2 and 1 case; for ative anatomy. When the treatment of the tumour
T4 (22 cases): 9, 8 and 5 cases. required a complete resection of the floor of
298 G. Dolivet et al.