Infrahyoid myocutaneous flap for medium-sized head and neck defects: Surgical outcome and technique modification

Objectives. To evaluate the surgical outcomes associated with infrahyoid myocutaneous flaps used in the reconstruction of medium-sized defects following head and neck cancer resection, as well as to discuss a novel technique modification. Study Design. Case series with chart review. Setting. University cancer hospital. Subjects and Methods. A total of 20 patients with oral or hypopharyngeal carcinoma who underwent infrahyoid myocutaneous flap reconstruction between June 2005 and December 2011 were retrospectively studied. A novel technical modification of flap harvest, preservation of the cranial portion of the anterior jugular vein, was attempted in 15 flaps and was successful in 13 flaps. Functional evaluation was performed in all patients 3 to 6 months after the operation or postoperative radiation. Results. Total flap necrosis, marginal skin paddle necrosis, and total skin paddle loss were observed in 1, 2, and 1 patient(s), respectively. Pharyngocutaneous fistula without flap problem occurred in 1 patient. No flap complications occurred in 13 cases where the cranial portion of the anterior jugular vein was successfully preserved. Functional results were excellent in 16 patients, good in 3 patients, and fair in 1 patient. Conclusion. The infrahyoid myocutaneous flap is a reliable and convenient technique that can serve as an alternative to free flaps in the reconstruction of medium-sized defects of the oral cavity or hypopharynx. Preservation of the cranial portion of the anterior jugular vein is a novel technical modification of harvesting this flap, which may result in better venous return of the skin paddle and reduce skin paddle necrosis.