Platysma Myocutaneous Flap Including the External Jugular Vein with Special Reference to Neck Dissection

Abstract

Although platysma myocutaneous flap (PTMCF) is suitable for a small intraoral defect, combination with neck dissection (ND) decreases the viability. Therefore, a version of PTMCF was devised to increase the viability. This version consists of three points: preservation of the external jugular vein (EJV), preservation of the facial artery after skeletonization from the submandibular gland, and a new incision around the flap. This procedure was applied to 21 patients with intraoral cancer. All 21 patients underwent some kind of ND. The average viable area of transferred skin was 80%. This rate was significantly better than that for 46 previous cases using Farr’s modification with ND, in which the facial artery was divided. Viability of the flaps was analyzed by the vessels preserved, especially by EJV. ND is not a contraindication with this version.

Defect closure after oral and pharyngeal tumor resection with the superiorly pedicled myocutaneous platysma flap: indications, technique, and complications

“…We would agree with authors such as Ruark et al [3], Verschuur et al [11], and Agarwal et al [19] that the external jugular vein should be ligated far distally whenever possible and should be routinely included in the flap pedicle. According to Saito et al [31], this procedure leads to a significantly higher likelihood that the MPF will survive. In addition, there are reports in the literature that ligation of the facial vein appears to be associated with a greater risk of inadequate perfusion of the MPF [6,21].…”

“…Partial flap necrosis was also observed in the present study in 33% of cases after ligation of the facial vein. Particular care should therefore be taken to ensure that venous drainage is provided by preserving other veins, particularly the external and anterior jugular veins [18,31].…”

Nasolabial Flap Reconstruction of Floor of Mouth

“…For small defects of the floor of the mouth, the following flaps have been used: submental flaps 6,15) ; platysma myocutaneous flaps 1,4,5,[17][18][19] ; pedicle flaps, such as buccal mucosa flaps which stem the facial artery; and free flaps, such as forearm flaps. However, while the use of the flap after neck dissection and radiation therapy is difficult, reconstruction using microsurgically anastomosed flap surgery can place a heavy burden on the patient 1,5,18) .…”

Anatomical Variations of the External Jugular Vein: A Pictorial and Critical Review

“…The EJV should be carefully identified at the posterior-superior border of the platysma muscle. Different flaps are used for intraoral reconstructions after cancer resection [ 19 ]. The platysma myocutaneous flap is suitable for small defects [ 19 ].…”

“…Different flaps are used for intraoral reconstructions after cancer resection [ 19 ]. The platysma myocutaneous flap is suitable for small defects [ 19 ]. The IJV drains the flap anteriorly, while the EJV drains it posteriorly [ 20 ].…”