Transcript Posteriorly based flap

SYSTEMIC REWIEW OF
THE PLATYSMA
MYOCUTANEOUS FLAP
FOR HEAD AND NECK
RECONSTRUCTION
PLATYSMA MYOCUTANEOUS FLAP
 Introduced by Futrell et al in 1978
 Myocutaneous axial distant flap
Origin:
 Upper part of pectoral and deltoid fasciae
 Fibres run upwards and medially
Insertion:
 Anterior fibres: base of mandible
 Posterior fibres: to the skin of lower face and lip
Potential design of platysma flap:
 Superiorly based flap with arterial blood supply
from the submental branch of facial artery
 Posteriorly based flap with arterial supply from
occipital and posterior auricular artery
 Inferior based flap with arterial supply from
transverse cervical artery
Superiorly based flap:
useful for reconstruction of anterior oral defects
 Floor of mouth
 Labial mucosa
 Buccal mucosa
 Alveolar ridge
 Portion of lip or chin
Posteriorly based flap: best suited for
 posterior oral mucosal or ridge defects
 Lower third of face
Posteriorly Based Platysma Flap
Superiorly Based Platysma Flap
Good venous drainage through external
jugular vein
Poor venous drainage through submental
vein
Collaterals of the superior thyroid artery
and occipital artery provide axial pattern
blood supply at the anterior border of the
sternocleidomastoid muscle
Good arterial blood supply through
submental branch of facial artery
Denervated muscle
Muscle may be elevated, preserving motor
innervation by cervical branch of seventh
cranial nerve
Arc of rotation allows for reconstruction of
lower lip, anterior and lateral floor of
mouth, ventral surface of tongue, and skin
of lower third of the anterior face
Arc of rotation allows for reconstruction of
anterior and lateral floor of mouth, buccal
mucosa, retromolar trigon, and skin of the
lower third of the cheek and parotid region
posteriorly based platysma myocutaneous
flap.
superiorly based platysma myocutaneous
flap.
Superiorly based platysma myocutaneous flap
Posteriorly based platysma myocutaneous flap
 Surgical technique:
Advantages:
 Easy to harvest , thin , and pliable
 Large enough to close upto 70 cm2
 Low donar site morbidity
 Functional impairment of deglutition, speech
and denture fitting is minimal
 Cervical skin defect is closed primarily along
with the neck incision , resulting in little or no
cosmetic defomity
Disadvantages:
 Blood supply can be unreliable
 When based on submental artery , this requires
preservation of muscularity in an area of
oncological significance which may have to be
addressed in the resection
 Lack of bulk
 Removal of the platysma interferes with the
blood supply to the overlying skin , which can
have disatrous results
 High rate of complications
Reported contraindications:
 Preoperative radiation
 Ipsilateral facial nerve paralysis
 Prior radical neck dissection
 Ligation of the facial artery
Complications:
 Partial or total flap loss
 Fistula
 Wound dehiscence
 Haematoma
 Infection
 Dale A. Baur, et al (J Oral Maxillofac Surg,
2002) studied 7 patients with posteriorly based
platysma flap used in reconstruction for various
tumor resection defects of the oral and facial
region.
 Three of the patients (43%)in this study had no
complications.
 Three patients (43%)had some skin sloughing,
but the underlying muscle remained viable and
mucosalized normally.
 One patient (14%) had 40% flap loss of the
distal end, possibly due to vascular compromise
that occurred during aconcomitant neck
dissection.
 Nikolaos Lazaridis, et al (J Oral Maxillofac Surg,
2007) studied the reliability and use of the
superiorly based platysma flap for
reconstruction of small and medium oral defects
in 5 patients
 Three patients (60%) had some skin sloughing
in the recipient site.
 None of the patients had complications in the
donor site.
 Deborah et al (Am J Surg June 1993)
 Retrospective analysis of 41 patients from
1980-1990
 Pre or post operative radiotherapy (39%) &
preoperative chemotherapy (73%)
 Flap related complications occurred in 8
patients (19%)
 These included partial flap necrosis, skin
necrosis of the neck suture line, and fistula
formation
 These results indicate that the platysma flap is
a viable alternate in reconstruction