Infrahyoid Myocutaneous Flap Research Articles

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.

Twelve Years of Establishing the Strategies for Tongue Reconstruction.

Reconstruction after resection of malignant tongue tumors remains one of the most difficult problems in head and neck oncology. Recent trends in tongue reconstruction have focused on optimizing speech and swallowing functions and maximizing quality of life. In the recent literature, several reconstructive strategies including regional flaps and free flaps have been described. A case series of 328 patients underwent oral tongue reconstruction between March 2011 and March 2022. Functional evaluation was performed in all patients 3 months after reconstruction (where the patients required no adjuvant radiotherapy) or after radiotherapy. Total flap necrosis was seen in 5 patients with free flap reconstruction (2 radial forearm flaps, 1 lateral arm flap, and 2 anterolateral thigh flaps), 5 patients with infrahyoid myocutaneous flap, and 1 patient reconstructed with a supraclavicular flap. Our success rate is 96.6%; partial flap necrosis was observed in 11 patients with infrahyoid myocutaneous flap and 2 patients with a supraclavicular flap. Most patients with subtotal glossectomy or smaller defects (type II-IVA defects) could communicate on the phone and had the near-normal capacity for an oral diet. The remaining patients (type IVB-V defects) had significantly lower speech scores. The majority of patients could eat liquid and semiliquid foods. Tongue cancer surgery and subsequent reconstruction posed exciting challenges for the surgeon to optimize tongue function and quality of life for patients. Attention to the principles of tongue reconstruction and choosing appropriate flap for each defect achieve better functional results.

The Infrahyoid Myocutaneous Flap an Unheeded Dimension in Head and Neck Surgery

The Infrahyoid Myocutaneous Flap an Unheeded Dimension in Head and Neck Surgery

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.

Kompartmentová chirurgia jazyka

Introduction: Compartmental tongue surgery is a surgical method that aims at removing of the tumor-affected half of the tongue and the regional lymph nodes en bloc in a standardized way to decrease an option of the locoregional recurrence. Material and methods: Description of the surgical technique, review of the literature and our first experience in the group of 11 patients is presented. Results: Out of 11 patients, 9 males and 2 females, with disease of the clinical stage I–IV, locoregional control has been achieved in 9 patients (81.8%). One female had a local recurrence, 1 female a regional recurrence. Five patients died, one female patient with regional recurrence, 2 patients with distant metastases, 1 patient due to duplex malignancy and 1 patient due to other reasons. R0 resection was detected in 8 patients and the other 3 patients had a close resection margin at different stages of the disease. The postoperative defect was reconstructed in 10 patients with an infrahyoid myocutaneous pedicled flap and in 1 patient with pectoralis myocutaneous flap. Conclusions: Compartment tongue surgery in indicated cases seems to be a good method for achievement of the locoregional control of the disease and negative margins. The data need to be confirmed on a larger group of patients with evaluation of other, particularly functional, parameters. Keywords: glossectomy – tongue cancer – tongue surgery

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.

New approach to an overlooked flap: Technique to augment venous drainage of the infrahyoid myocutaneous flap.

To describe a technique in which the anterior jugular vein is preserved in the infrahyoid myocutaneous flap (IHMCF) to augment skin paddle venous drainage. From April 2018 to December 2019, 14 patients with primary oral cancer underwent radical resection and IHMCF reconstruction. Three-dimensional reconstruction of the anterior jugular vein was used to assess the venous drainage of the skin paddle preoperatively. The anterior jugular vein was preserved during dissection of the flap. Healing of the recipient and donor sites was observed. Total flap necrosis occurred in one patient and marginal skin paddle necrosis occurred in one patient. No flap complications occurred in the other 12 patients. This new approach to augment venous drainage of the IHMCF appears to be effective for decreasing risk of flap necrosis.

One-Stage Tracheal Reconstruction using a Modified Infrahyoid Myocutaneous Flap in a Patient of Papillary Thyroid Carcinoma with Tracheal Invasion

舌骨下筋皮弁を用いて気管欠損部の一期的再建を行った.

A patient in whom reconstruction was performed using an infrahyoid myocutaneous flap after resection of cancer of the oral floor

A patient in whom reconstruction was performed using an infrahyoid myocutaneous flap after resection of cancer of the oral floor

Usefulness of infrahyoid myocutaneous flap for reconstruction after resection of oral cavity cancer:

Usefulness of infrahyoid myocutaneous flap for reconstruction after resection of oral cavity cancer:

The infrahyoid myocutaneous flap for reconstruction after oral cancer resection: A retrospective single-surgeon study.

ObjectiveTo review our experience with infrahyoid myocutaneous flap in reconstruction after oral cancer resection.MethodsChart reviews were completed for all patients who underwent oral reconstruction with an infrahyoid myocutaneous flap by a single surgeon in the Department of Otolaryngology at Chonburi Cancer Hospital from 2011 to 2017. Characteristics of the patients and postoperative complications were analyzed.ResultsOf the 34 patients in the study, 10 (29.4%) developed partial flap loss and 1 (2.9%) developed total flap loss. All cases of partial flap loss resolved with conservative treatment. Apparent cancer involvement of a cervical lymph node was significantly associated with flap failure (odds ratio: 5.0, 95% CI: 1.03–24.28).ConclusionsThe infrahyoid myocutaneous flap is a fairly reliable reconstruction method. The flap should be performed with caution in cases with gross lymph node involvement.

Infrahyoid Myocutaneous Flap Versus Radial Forearm Free Flap in Treating Patients with cT1-2 Tongue Carcinoma

Our goal was to compare clinical and functional results of the infrahyoid myocutaneous flap (IMF) with those of the radial forearm free flap (RFFF) for partial tongue reconstruction. Between January 2005 and June 2012, patients who had received an IMF or a RFFF reconstruction for cT1-2 tongue carcinoma were included, their medical records were reviewed, and they were asked to complete the University of Washington Quality of Life (UW-QoL) version 4 questionnaire at least 12 months postoperatively. Compared to patients with a RFFF reconstruction, patients treated with an IMF had significantly shorter operation time (p<0.001), less hospital cost (p<0.001) and shorter postoperative stay (p<0.001). There were no apparent differences in other scales between the two groups. The mean composite score for the two groups was 88.4 (SD: 14.9) and 86.4 (SD: 15.3), respectively, the finding was not significant (p=0.784). Patients with an IMF reconstruction had significantly better shoulder function, there were no significant differences regarding other domains between the two groups. Compared to RFFF, IMF was a reliable procedure for partial tongue reconstruction.

Modified Incision Design for Submental Flap: An Excellent Design Method for the Reconstruction of a Defect after Head and Neck Tumor Resection

BackgroundThe usage of submental flap is a good method for head and neck reconstruction, but it has some risk also, such as anatomical variations and surgical errors. In this article, we present a modified incision design for the submental flap.MethodsWe designed a modified submental flap incision method based on the overlap of the incision outline of the submental flap, platysma myocutaneous flap and infrahyoid myocutaneous flap. If we found that the submental flap was unreliable during the neck dissection at the level III, II and Ib areas, the infrahyoid myocutaneous flap or platysma myocutaneous flap was used to replace it. Between 2004 and 2012, we performed 30 cases using this method. As control, 33 radial forearm free flaps were counted. Significant differences were evaluated using the χ2 test and Mann-Whitney U. Survival and recurrence were analyzed using the Kaplan-Meier method.ResultsOf the 30 patients, 27 finally received a submental flap, 1 patient received an infrahyoid myocutaneous flap, and 2 patients received a platysma myocutaneous flap. In patients who received the submental flap, the average operation time was 5.9 hours, 2.4 hours shorter than the radial forearm free flap group; the average age was 61.8, 6.1 years older than the radial forearm free flap group; the survival time and recurrence time did not significantly differ with those of the forearm free flap group; and the success rate was higher than traditional methods.ConclusionsThe wider indications, less required time, the similar low risk of recurrence and death as radial forearm free flap, higher success rate than traditional submental flap harvest methods, and ability to safely harvest a submental flap make the modified incision design a reliable method.

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.

Infrahyoid Myocutaneous Flap for Medium‐Sized Head and Neck Defects

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. Case series with chart review. University cancer hospital. 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. 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. 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.

Anatomical study and modified incision of the infrahyoid myocutaneous flap

Skin paddle necrosis and neck function damage, particularly rotation, are two problems associated with the infrahyoid myocutaneous flap clinical application. The aim of this study was to investigate vessel supply and drainage of the skin paddle and to report our modified flap incision technique. In this work, we conducted a cadaveric study and reviewed our experience with the modified incision and describe the surgical procedure. We confirmed the platysma muscle branch feeds the skin paddle overlying the infrahyoid myocutaneous flap. The length between the platysma muscle branch entry point and its originating point measured 3.38 (min 2.51, max 4.52) cm. The flap has two drainage systems. The skin paddle of the flap was drained by the anterior jugular vein and external jugular vein, respectively, or both. The infrahyoid muscles were drained by the superior thyroid vein. In the early four cases, where the platysma muscle branch was not protected, skin paddle necrosis appeared in two cases. In the later seven cases, which involved preservation of the platysma muscle branch, all flaps successfully survived. Patients in whom a modified incision was used all achieved both satisfactory rehabilitation of neck function and an adequate esthetic result. We conclude that the necrosis rate of the skin paddle of the flap can be reduced by carefully protecting its supply and drainage vessels. The modified incision can improve neck function postoperatively.

Tracheal reconstruction with a modified infrahyoid myocutaneous flap

Reconstruction of a tracheal defect is a challenge because it often requires invasive surgery associated with relatively high morbidity. We recently invented a less-invasive method using a modified infrahyoid myocutaneous (IHMC) flap for the reconstruction of a tracheal defect in an 83-year-old male. A tracheal defect, the right half of the cricoid cartilage plus the right three quarters of the I-IV tracheal cartilage (about 3 × 4 cm), was reconstructed with a modified IHMC flap composed of the sternohyoid and platysma muscles and a skin pedicle. Considering the age of patient, we avoided rigid reconstruction and used a soft silicone tracheal opening retainer (Koken Co., Ltd., Tokyo, Japan) as an anterior wall dilator after surgery and waited for the scarring of the flap until it become rigid enough. The postoperative course was uneventful and the trachea was reconstructed safely. Tracheal reconstruction with an IHMC flap is a useful and less-invasive alternative compared to end-to-end anastomosis or reconstruction with a forearm flap, which is currently used as a mainstay.

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