Infrahyoid Flap Research Articles

Infrahyoid myocutaneous flap for reconstruction in head and neck cancer patients

Background: Reconstruction of head and neck defects following tumor excision is one of the most challenging surgeries due to multiple reasons, such as associated cosmetic and functional impairments. The three-dimensional aspect of the defect makes it more difficult. Although in modern settings, microvascular surgery is preferred in many conditions, it requires the presence of resources and expertise. Locoregional flaps are workhorse flaps in head and neck reconstruction. In this article, we present an uncommonly used flap with high acceptability and success rate in head and neck reconstruction. Aim: To find outcomes of using infrahyoid flap reconstruction in head and neck defects following cancer excision. Materials and Methods: The retrospective study was conducted in the surgical oncology department of our institute. Patients with squamous cell carcinoma of the oral cavity, clinically T1–T3 and N0–N1 stage, with anticipated defects of small to medium defects were included in the study. The study was conducted from July 2020 to June 2022, including a follow-up of 1 year. A total of 14 patients were included in the study. All patients had squamous cell carcinoma of the oral cavity involving different subsites. Patients were operated on by a single surgeon, using the same technique. Result: A total of 14 patients were included with a male-to-female ratio of 11:3 and age between 45 and 60 years. None of the patients underwent revision surgery, and none of the patients had total flap loss. Four patients had minor flap complications, of which three patients had partial, superficial skin necrosis of the flap which was managed conservatively and epithelized later. None of the patients developed major complications, oro-cutaneous fistula, or radiation necrosis. None of the patients developed recurrence after 1 year of surgery. Conclusion: The infrahyoid myocutaneous flap (IHF) is a fairly reliable and easy-to-perform flap for small- and medium-sized defects of the oral cavity, without requiring additional incisions and donor site reconstruction.

Local Flap Reconstructions in Oral Cavity Defects: An Insight from 104 Cases.

Resection of oral cavity carcinoma often leads to complex defects causing functional and aesthetic morbidity. Providing optimum reconstruction with free flaps becomes challenging in a high-volume center setting with constrained resources. Hence, understanding the local flap technique for reconstructing oral cancer defects is prudent. This study is a retrospective analysis of prospectively operated cases of oral cavity resections which were subsequently reconstructed using local flaps from 2019 to 2022. Patients who underwent reconstruction with either melolabial flap, islanded facial artery myomucosal (FAMM) flap, submental flap, supraclavicular artery island flap, infrahyoid flap, or platysma myocutaneous flap (PMF) were included in this analysis. Eligible patients were followed up to evaluate functional outcomes like oral feeding and to analyze the Performance Status Scale for Head and Neck Cancer. The study included 104 patients. The tongue was the most common subsite, resulting in most hemiglossectomy defects, which were reconstructed using the melolabial flap procedure. Buccal mucosa defects in our series were reconstructed using the supraclavicular flap, whereas the submental flap procedure was the choice for lower lip-commissure defects. Complications such as partial and total flap loss, deep neck infection, and donor site complications like infection and gaping, oral cutaneous fistula, parotid fistula, and seroma were analyzed; the supraclavicular flap presented with a majority of complications. Local flaps are an alternative to free flap reconstruction in select cases with optimum functional outcomes and minimal donor site morbidity. This article comprehensively reviews the surgical steps for various local flap procedures in oral cancer defects.

Infrahyoid Myocutaneous Flap for Reconstruction in Head and Neck Cancer Patients

Objective: Oral cancers are one of the most common cancers in India. Tongue and lower gingiva-buccal sulcus are the most common subsites in oral cancers. Good reconstruction after resection of primary is a demanding task and determines quality of life. This study reviews our experience with infrahyoid flap (IHF) in reconstruction of small and medium sized defects after oral cancer resection. Materials and Methods: This study retrospectively analyzes all patients of oral cavity squamous cell carcinoma who underwent IHF flap by a single surgeon from July 2018 till June 2022 with a median follow‑up of 12 months. Results were analyzed based on characteristics of the patients, site and size of defect, postoperative complications and clinical outcome. Results: Out of 14 patients, 4 patients had skin paddle necrosis (2 total and 2 partial). None of the patient suffered a total flap loss. All cases of partial flap loss resolved with conservative treatment and none of the patient required a revision surgery or developed orocutaneous fistula. The largest flap size was 9 × 4.5 cm. Conclusion: The infrahyoid myocutaneous flap is a fairly reliable and easy to perform flap for small and medium‑sized defects of the oral cavity.

Reconceptualizing the Application of Infrahyoid Flap in the Era of Free Flaps in a Developing Country

Objective: To review our clinical experience with infrahyoid myocutaneous flap which is often overlooked in the reconstruction of small to medium-sized tongue, floor of mouth, lower alveolus and gingivobuccal sulcus primary defects. Method: A retrospective study of 12 patients of squamous cell carcinoma involving the tongue, floor of mouth, mandibular gingivobuccal sulcus and alveolus was done in patients who underwent infrahyoid flap as an alternative to free radial forearm flap. This study was conducted in the Tertiary Care Institute. The study included patients treated between March 2020 to May 2021. Patients with T4 and N3 disease, recurrence cases, post-radiation, and chemo-radiation cases who refused to participate in the study were excluded. Results: Out of 12 patients, two patients developed partial flap necrosis. One patient developed a hematoma under the flap and one patient had a neck suture gaping. Postoperative results were found to be phenomenal after one month in all patients. Conclusion: The infrahyoid flap is a dependable, less arduous, and economical option for small to medium-sized defects of the oral cavity. It can be advised as a possible substitute for free flap reconstruction, especially in a developing country where resources are limited.

Infrahyoid flap—a good substitute for free flaps in oral reconstruction during the COVID‐19 pandemic

AbstractAimDuring the coronavirus disease 2019 (COVID‐19) pandemic, experts have recommended simplifying the process of reconstruction following the extirpation of head and neck cancer by favouring the use of pedicled flaps over free flaps. This approach reduces the duration of the operation and mitigates the risk of free flap failure, which can be exacerbated by the hypercoagulopathy state seen in infected patients. We aim to contribute our experience with the pedicled infrahyoid flap, a procedure not previously reported in Hong Kong.Patients and MethodsWe conducted a retrospective study including patients who underwent infrahyoid flap reconstruction following resection of oral cavity cancer. Data for a total of nine patients were retrospectively retrieved from the hospital's computerised systems, and these patients were evaluated for demographic information, clinicopathologic parameters as well as oral function and reconstruction outcomes.ResultsAmong the nine infrahyoid flaps used, eight were myocutaneous flaps and one was a muscle flap. The dimensions of the flap skin ranged from 24.0 to 46.72 cm2. All of the flaps, with the exception of one case that experienced epidermolysis of the flap skin, exhibited complete survival. Fortunately, the epidermolysis healed without complications, such as the development of an orocutaneous fistula. The average time required for flap harvesting was approximately 1 hour. All nine patients were able to resume oral feeding and achieved satisfactory speech outcomes. Seven of these patients survived without any tumour recurrence, but unfortunately, two patients died due to lung metastases.ConclusionsThe infrahyoid flap proves to be a viable alternative to free flaps for the repair of medium‐sized oral defects, especially in compromised patients and during the COVID‐19 pandemic.

Evaluation of treatment outcome amongst two different treatment modalities for reconstruction of carcinoma of tongue patients: The infrahyoid myocutaneous flap versus radial forearm flap.

Oral cancer is one of the most common cancers not only in India but also in South Asia. Treatment of oral cancer is not only limited to cure but also requires good reconstruction of the surgical defects for a better quality of the life. There are many well-proven options for reconstruction purposes for the defects of the oral cavity including local regional flaps to microvascular-free flaps. After resections of mobile parts of the tongue (up to 50%) speech and swallowing are impaired significantly, however, even after sophisticated plastic reconstruction, serious swallowing and speech problems persist. The pilot study was carried out after the allocation of fourteen patients with carcinoma of the tongue into two treatment test groups; the Radial forearm flap (RFF) and Infrahyoid neuromuscular flap (IHF) group to evaluate and compare the treatment outcome for reconstruction using two different treatment modalities. The pilot study was carried out after the allocation of fourteen patients with carcinoma of the tongue into two treatment test groups. the clinical parameters likewise swallowing reflex, speech analysis, donor site complication, time taken for the surgery, and cost-effectiveness of the flap was evaluated using IBM SPSS Statistics for Windows software, 20.0 (IBM Corp., Armonk, USA). The data were numerically coded and entered into the program. Both the descriptive statistics and the inferential statistics involving one-way ANOVA and Tukey's Post Hoc test were analyzed to compare both intergroup and intragroup comparisons at different time intervals. The swallowing and aspiration analysis showed a highly statistically significant difference at 3 months and 6 months by Post Hoc test between the groups. The speech analysis scores at all intervals were not statistically significant while for tongue movements the results were significant. The time taken and expenditure for surgery by IHF were less in comparison to RFF. The infrahyoid flap is a quick, easy, and reliable reconstructive method, which is cost-effective when used with knowledge of its clinical utility and limitations, the functional results are excellent with great patient satisfaction.

Retalho miocutâneo infra-hióideo em defeitos de cabeça e pescoço: experiência de uma única instituição

ABSTRACT Introduction: The infrahyoid flap is a pedicled flap with a simple harvesting technique. It may be an alternative for free flaps in elderly or patients with multiple comorbidities. This article evaluates 15 patients submitted to reconstruction of head and neck defects. Case report: Case series of patients submitted to infrahyoid flap reconstruction in a referral center. We evaluate surgical and functional outcomes associated with reconstruction with infrahyoid flap from November of 2013 to May of 2017. Conclusion: Infrahyoid flap is a thin and flexible flap with low rates of complications and does not require another surgical team. The majority of the patients had complete functional rehabilitation. Keywords: Reconstructive Surgical Procedures. Myocutaneous Flap. Surgical Flaps. Head and Neck Neoplasms.

Oncological safety of harvesting local flaps from the neck in clinically node positive patients with oral squamous cell carcinoma.

e18065 Background: Reconstruction of complex orofacial defects following tumour resection has always posed as a challenge for clinicians for providing functional and morphological outcomes. Though microvascular free flaps revolutionized reconstruction, local flaps provide a viable alternative in resource constraint settings. Oncological safety of harvesting local flaps has always been a matter of debate in oral squamous cell carcinoma due to proximity of nodal stations. Available literature on oncological safety is limited to clinically node negative patients. The purpose of this study was to evaluate the oncologic safety of local flaps in clinically node positive patients. Methods: Retrospective analysis of data available of all patients diagnosed with clinically node positive oral squamous cell carcinoma who underwent modified radical neck dissection at Malabar Cancer Centre during the period January 2012 to December 2017 was done. Demographic profile, tumour characteristics and pathological outcomes were compiled. The factors included were pathological tumour, nodal stage, levels of nodes involved, extranodal extension, choice of flap and site of recurrence. Fisher's exact test was used to compare recurrence patterns between local and regional flaps. Results: A total of 309 clinically node positive patients were analyzed with a median follow up of 4 years. Overall incidence of pathologically proven nodal metastases to ipsilateral levels Ia Ib, II, III, IV and V were 8.1%, 35.3%, 39.5%,15.5%, 2.9% and 1.3% respectively. Level Ia was most commonly involved in buccal mucosa and tongue cancers. Levels Ib, II, III were most commonly involved in tongue and buccal mucosa cancers. Level IV was commonly involved in tongue cancers while level V in cancer of retromolar trigone. Local flaps analyzed were submental flap (2.6%), supraclavicular flap (2.6%), infrahyoid flap (2.6%), sternocleidomastoid muscle flap (4.5%), nasolabial flap (1.3%), facial artery myomucosal flap (1.6%). Pathological nodal positivity was 60% and 52% in local and regional flaps respectively. Amongst the patients who had reconstruction with submental flap there were no nodal recurrences at level Ia, only 1 patient had recurrence at flap site. Amongst the patients who had reconstruction with supraclavicular flap there was 1 patient with pathological involvement of level V as per histopathological report but no nodal recurrences at level V. There was no difference in pattern of nodal recurrence between local and regional flaps (p = 0.436). Conclusions: This retrospective analysis is the first of its kind analysing the oncological safety of harvesting local flaps in clinically node positive oral squamous cell carcinoma. Thus, with appropriate management of the levels Ia and V nodal compartment, oncologic outcomes are not compromised, thereby making it oncologically sound to harvest local flaps in N+ neck.

The Role of Infrahyoid Flap in Tongue Defect Reconstruction Following Tumour Excision.

Carcinoma tongue is one of the commonest cancer of head and neck in India. Various pedicled and free flaps have been used to reconstruct the tongue defect following glossectomies. In this era of free flaps various loco- regional pedicled flaps have been overlooked and infrahyoid flap is one of them. This flap meets the functional and cosmetic acceptance of the tongue defect reconstruction with minimal morbidity to the donor site. This paper presents author's experience of using infrahyoid flap in 10 patients of carcinoma tongue. In all the patient's tongue defect was closed with the infrahyoid flap, in 1 case flap necrosed fully and in 1 partially. Functional outcome and quality of life in all the patients were acceptable.

Novel modification of infrahyoid myocutaneous flap for the reconstruction of oral cavity defects

This study was intended to describe the technique used and the results obtained with the modification of the infrahyoid flap (IHF) for the reconstruction of oral tongue defects following resection for advanced squamous cell carcinoma (SCC). Patients with oral tongue defects following ablation for T2 to T4a SCC had reconstructions using a modified infrahyoid flap. Demographic data, tumour characteristics, and the complications were evaluated for each patient. We observed no complications regarding the healing process of the donor site or success of the flap in 49 (of 55) patients. None of the flaps had massive oedema or venous congestion in the postoperative period. Six patients experienced flap-related complications of which five had partial skin paddle necrosis, but eventually their flaps recovered and re-epithelialised without any further intervention. However, total flap necrosis was seen in one patient in whom a pectoralis major flap was used for the defect reconstruction following revision surgery. History of previous radiotherapy to the neck (p = 0.003), tumour stage (p = 0.017), and metastasis to cervical lymph nodes (p = 0.004) were associated with higher prevalence of partial or total flap necrosis. The modified infrahyoid flap is a reliable, quick, and simple procedure with a reasonable cost that makes it a valuable option for the reconstruction of the oropharynx and oral cavity with minimal donor site morbidity and good outcomes. It seems the modified IHF is a valid surgical procedure that may be considered in selected patients undergoing reconstruction of oncological oral tongue defects with fewer complications.

Voice rehabilitation after total laryngectomy with the infrahyoid musculocutaneous flap

Background It is important for the patients to reconstruct the voice phonic function by surgery after total laryngectomy in the developing countries. Aims/Objectives To investigate the clinical outcomes of voice reconstruction using an infrahyoid musculocutaneous flap for patients after total laryngectomies. Materials and methods Eighteen male patients recruited were laryngectomized. The infrahyoid musculocutaneous flap was designed. After total laryngectomy, the lower edge of the flap was sewed with the upper edge of the tracheostomy opening. Next, the lateral and medial edges of the flap were anastomosed to create a pronunciation tube. Finally, the remaining opening of the tube was sutured with the anterolateral wall of the hypopharynx to establish a communication with the pharyngeal cavity. Results A total of 17 cases of flaps were survived and only 1 necrosed. There were 17 patients without serious complications, except that 6 cases had mild irritable cough when gulping water. However, it could be relieved through blocking tracheostoma. One year after operation, all patients could more remarkably articulate clear, powerful, and consistent words. The articulatory configuration was existed under rigid laryngoscope and CT. Conclusions and significance The use of an infrahyoid myocutaneous flap is feasible for the voice restoration in the patients undergoing total laryngectomy.

Partial pharyngolaryngectomy with infrahyoid flap: Our experience.

We evaluated a cohort of advanced hypopharyngeal squamous cell carcinoma, treated with conservative surgery, reconstruction with infrahyoid flap and radio-chemotherapy. We used partial pharyngo-laryngectomy and radio-chemotherapy to treat fifty-seven patients with stage III-IV hypopharyngeal SCC from November 1994 to December 2011. Clinical examination and speech therapy evaluation were used for estimation of laryngeal function. All patients received a partial pharyngo-laryngectomy. All patients underwent neck dissection; 56 patients received bilateral neck dissection. Reconstruction was achieved by infra-hyoid flap. Five-year overall and disease-specific survival rates were 54.4% and 61.4%, respectively. Successful laryngeal function preservation with complete five-year remission was achieved in 44% of the patients. Selected even if advanced carcinomas of the hypopharynx maybe treated with partial pharyngo-laryngectomy with reconstruction with pedicled flap. Both oncological and functional results showed a good outcome.

Infrahyoid Flap, a Convenient Alternative for Reconstruction of Tongue and Floor of Mouth Defects: Case Series.

The aim of this study was to share our clinical experience with the neurovascular myofasiocutan infrahyoid flap (NMIHF), which was used for the reconstruction of the defects after oral cavity cancer surgery. Records of five patients who were diagnosed with oral cavity cancer and underwent tumor resection, neck dissection, and defect reconstruction with NMIHF between 2012 and 2017 were analyzed retrospectively. The infrahyoid flap was used in five patients: four males and one female. The mean age of patients was 61.8 years. Four patients underwent tumor resection and bilateral level I-III neck dissection, whereas one patient underwent tumor resection and unilateral level I-III neck dissection. NMIHF was used for the reconstruction of the defects during the same procedure in all the patients. Mean post-operative follow-up was 30.6 months. Partial skin necrosis was observed in two patients, but none of the patients showed total necrosis of the flap. Postoperatively, oral intake was initiated after an average of 12 days in all patients. For two patients who required post-operative radiotherapy (RT), the treatment was started after an average of 50 days. NMIHF does not prolong operation time and does not cause additional scar in the neck, and the defect in the donor field can be closed without the use of a graft or flap. This is considered to be a reliable and successful alternative to free flaps for the reconstruction of oral cavity defects.

ONCOLOGICAL RESULTS OF SURGICAL TREATMENT EFFECTIVENESS OF STAGE I AND II ORAL CAVITY CANCER

Introduction . Surgical intervention is the main method of treatment of oral cavity cancer, and at early stages it»s a monomodal treatment. The study objective is to determine oncological effectiveness based on an analysis of surgical treatment of stage I and II oral cancer. Materials and methods . In the period from April 2009 to December 2014, 52 patients (37 men and 15 women) aged 39–85 (mean age was 60.2 years) with confirmed diagnosis of squamous cell carcinoma of the tongue (36 patients), the floor of the mouth (15), and the retromolar trigone (1) underwent surgery. Half of the patients were stage I, the other half – stage II. Removal of the primary tumor was accompanied by neck dissection in 35 cases (67 %). Dissection was two-sided in 8 patients. Twenty (20) modified radical dissections and 23 selective neck dissections were performed. In the majority of cases (42 patients, 80.8 %), tumors were removed transorally. Primary reconstruction was performed in 31 patients; in others, additional plastic material was used: infrahyoid flap (14 cases), submental flap (1), radial forearm flap (5), anterolateral femoral flap (1). Survival was evaluated using the Kaplan–Meier estimator incorporating patient’ dates of last visits or death. Progression-free survival took into account time to diagnosis of disease relapse in the form of local or regional recurrence. Statistical data analysis was performed using the SPSS v. 23 software. Results. Mean follow up duration was 37.4 months (1–91 months), and 27 patients (52 %) were monitored for 3 and more years, 34 (65.4 %) patients after surgery for 2 years and longer, and 46 (88.5 %) patients for more than a year. During this time, 8 patients died, and 3-year overall survival was 84.7 %. In 6 patients, disease recurrence was diagnosed, in 2 of them this event was registered twice (local recurrence in 3 cases, regional recurrence in 4 cases, locoregional recurrence in 1 case). Therefore, locoregional control was 88.5 %. Time to recurrence varied from 4 to 43 months. Three-year relapse-free survival was 91.1 %. Second primary tumors appeared 30–70 months after surgery in 4 patients: In 2 patients, they were located in the oral cavity, in 1 – in the larynx, and in 1 – in the laryngopharynx. Statistical analysis of various factors (Т stage, differentiation grade, localization, etc.) has shown that only neck dissection affected overall 3-year survival: it was 96 % in patients with neck dissection, and 64.3 % in patients without neck dissection (р = 0.012). However, these data can be explained by older age of patients who didn’t undergo neck lymph node dissection (65.2 vs. 57.6 years), and presence of a more severe concomitant pathology. Conclusion. Surgical intervention remains the main treatment method of early stage oral cavity cancer due to its high oncological effectiveness.

Islanded facial artery musculomucosal flap for tongue reconstruction

Reconstruction of the tongue can be achieved by means of various local, regional, and microvascular free flaps. Local flaps commonly used for tongue reconstruction include the nasolabial flap, submental flap, infrahyoid flap, and pedicled facial artery musculomucosal (FAMM) flap. The purpose of this article is to propose a technical modification to the FAMM flap for the reconstruction of small to medium-sized tongue defects post tumour excision: islanding the flap and tunnelling it from the lingual aspect of the mandible in a single-stage procedure. Islanding of the FAMM flap was found to be an extremely useful modification, giving excellent range of movement for the flap and eliminating the need for revision in a second stage procedure.

Infrahyoid flap in oropharyngeal reconstruction following carcinoma resection: A study of 6 patients and literature review.

The present study aimed to describe the techniques used and the results obtained with the infrahyoid flap for the reconstruction of medium-sized oropharyngeal defects following resection for advanced squamous cell cancer. During a period of 1 year, six patients with oropharyngeal defects were reconstructed using the infrahyoid flap. The tumor characteristics, location and size of the defect, resective and reconstructive techniques employed and the complications and outcomes of the speech and swallowing functions, as identified in the follow-up visits every 3 months, were evaluated. All flaps were performed simultaneously in association with tumoral excision and ipsilateral supraomohyoid neck dissection. The mean size of the skin paddle was 7.0×3.5 cm. The donor site was primarily sutured. The postoperative course was uneventful and all flaps were viable. One case of marginal skin paddle loss occurred without affecting the survival of the flap. Five patients received postoperative radiotherapy and one patient received concurrent postoperative chemotherapy. During the follow-up period (mean, 63 months), all patients showed excellent oral swallowing. Speech was excellent in five patients and in one patient speech was classified as good. The aesthetic results of the cervical donor site were good. Based on the present case report and the literature review, the infrahyoid flap is a simple and safe procedure for the reconstruction of the oropharynx, with a high success rate, minimal donor site morbidity and good aesthetic and functional results. The infrahyoid flap is a valid surgical option that may be considered in selected oncological patients undergoing reconstruction of medium-size oropharyngeal defects.

PP163: Oral and pharyngeal reconstruction with infrahyoid myocutaneous flaps-update

Purpose The use of pedicled myocutaneous flaps in head and neck reconstruction is widely accepted. We describe retrospectively our experience with infrahyoid flaps (IHFs employed to cover surgical defects in the oral cavity and oropharynx in patients with benign and malignant tumors. The aim was to evaluate the success rate for infrahyoid myocutaneous flap procedures performed at a single institution. Methods Twenty-four IHF were used to reconstruct surgical defects in twenty men (83.3%) and four women (16.7%) with a mean age of 61.8 years. The anterior floor of the mouth was reconstructed in 14 patients (58.3%), the lateral floor in five (20.8%), the base of tongue in 3 (12.5%), the retro molar area and oro-posterior wall of hypopharynx in one case each (4.1%). Twenty-two patients (91.6%) had squamous cell carcinoma (SCC) and two (8.3%) ameloblastoma. Of the SCC cases, the disease stage was T3 in 14 (63.6%) and T4 in 8 (36.3%). All patients were submitted to selective unilateral or bilateral neck dissections. Results No patient presented total flap loss or fistula. The most common complication was epidermolysis, which was important in five (20.8%) patients, delaying the beginning of oral ingestion. However, oral feeding was started on average at eight days. Four (16.6%) patients required postoperative speech therapy. The patients with SCC received postoperative radiotherapy with no major consequences to the flap. Conclusions IHF is a safe and reliable procedure for reconstructing head and neck surgical defects. Due to its thinness and malleability, its use for oral cavity and oropharynx defects provides favorable cosmetic and functional outcomes. Complications, when present, are easy to manage.

Cervical oesophageal and hypopharyngeal perforations after anterior cervical spine surgery salvaged with regional and free flaps

Background and purposeThe object of the study was to present our own experience in the management of cervical oesophageal and hypopharyngeal perforations after anterior cervical spine surgery. Material and methodsThe study group consists of 5 patients treated in Department of Otolaryngology Poznan University of Medical Sciences in 2009–2011. Different materials and techniques were used to repair the perforations: infrahyoid flap, primary sutures supported by sternocleidomastoid muscle flap, thigh flap and forearm flap in two cases. ResultsFour out of 5 patients were referred to our department in a poor general condition, with infected neck fistulas, three patients after prolonged conservative treatment, and three patients after initial attempts to repair the perforation outside our institution. One-stage reconstructive surgery was successful in three cases, while in two others secondary interventions were necessary. Total hospital stay ranged in the analysed group from 23 to 191 days, hospital stay in our department from 1 to 62 days, hospital stay from the final procedure from 18 to 26 days. Swallowing function was within normal limits in all cases 12–14 days after the surgery. ConclusionsThe authors’ experience shows that in long-lasting and infected cervical oesophageal and hypopharyngeal perforations following anterior cervical spine surgery distant flaps should be primarily used as a source of a well-vascular-ized and unchanged tissue. It seems to be crucial to repair the perforations immediately after the first symptoms appear – such an approach significantly reduces total hospital stay and improves the prognosis.

Reconstructive Option of Extensive Head and Neck Defects in Cancer Surgery

Aim of the study was to present the best methods for reconstruction of extensive defects after removal of the head and neck cancer. Key to success of reconstrucive surgery is choosing an appropriate option that aim at single stage replacement of lost tissue and provide the integrity, function and aesthetic outcome in a perfect balance. This descriptive study was carried out between march 2009. And march 2013. at the Clinic of Maxillofacial surgery, Clinical center of University of Sarajevo, Bosnia and Herzegovina. A total number of 483 patients with extensive defects were included. Most of the patients 421 (87%) were males. The diagnosis of squamous cell carcinoma was present in 355 (73.5%) cases wich was statistically significant. Pectoralis major myocutaneous flap was the most common reconstruction method, in 267 (55.3%) cases. Second common method used were local flap 147 (30.4%), then temporal flap 36 (7.5%). Infrahyoid flap, latissimus dorsi, radial forearm free flap and free fibula graft were also used. The prevalence ofpectoralis major myocutaneous flap was statistically significant. The most comon complication among donor and recipient side was hematoma. Total flap necrosis occured in 9 (1.9%) patients. Comparing donor and recipient side in common complications there were no statistical significant difference. Wich technique for closure to choose depends on the complexity of defect. The pectoralis major myocutaneous flap continues to be the most universal flap in head and neck reconstruction.

Application of infrahyoid myocutaneous flap in the reconstruction for early stage mouth floor carcinoma

Objective To evaluate the clinical value of infrahyoid myocutaneous flap in the reconstruction of mouth floor tissue defects. Methods Infrahyoid myocutaneous flap was made including stenohyoid,thyrohyoid,omohyoid and the affiliated skin based on the axis of superior thyroid artery,vein and ansa cervicalis. The clinical data of 11 patients with reconstruction of mouth floor tissue defects using infrahyoid myocutaneous flap (maximum area was 8 cm × 3 cm) from Match 1993 to June 2009 were retrospectively reviewed.Results Seven infrahyoid myocutaneous flaps which reserved platysma branch of superior thyroid artery were all alive, while 2 patients presented epidermal necrosis of 4 un-protected patients. The follow-up period was range from 24 months to 195 months, one patient received salvage surgery for local regional lymphatic recurrence in level Ⅰ,which survived without diseases until now.The rest cases had turned out a success.No dysphagia,dysphonia,and tongue extension difficulty was reported in any patient. Conclusion Infrahyoid myocutaneous flap is one of the valuable donor sites for the reconstruction of mouth floor tissue defects after radical oncologic operations,especially for those with early stage carcinoma of the mouth floor. Key words: Carcinoma of mouth floor; Infrahyoid mycutaneous flap; Micosurgical operation