Infrahyoid Flap for Reconstruction of Head and Neck Defects

Presentation: AHNS009
Topic: Reconstruction and Rehabilitation
Type: Oral
Date: Wednesday, April 18, 2018
Session: 10:30 AM - 11:20 AM Reconstruction and Rehabilitation
Authors: Marianne Nakai, MD, Juliana Maria de Almeida Vital, MD, Marcelo Benedito Menezes, PhD, William Kikuchi, MD, Antonio Jose Goncalves, PhD
Institution(s): Irmandade da Santa Casa de Misericórdia de São Paulo

The infrahyoid flap was first described as a myofascial flap by Clairmont and Conley on 1977. It is mainly used for oral cavity, oropharyngeal defects, but it has also been described for parotid region, pharyngolaryngeal tract and cervical tracheal reconstruction defects and as myofascial transposition preventing fistula after total laryngectomy and for reconstruction of iatrogenic fistulas on cervical spine surgeries. It may also be an alternative for microsurgical free flaps in elderly or patients with clinical comorbidities. The infrahyoid flap is harvested after the neck dissection and it usually is ipsilateral to the defect.

Materials and Methods: A total of 12 patients submitted to reconstruction of head and neck defects from November of 2013 to May of 2017 and followed up until October of 2017 were retrospectively studied.

Results: Twelve patients were included, 3 females and 9 males, with an average age of 62,7 years. From those 12 patients, the flap was used for the reconstruction of oral cavity cancer resection on 8 patients (04 tongue, 03 floor of the mouth and 01 cheek mucosa). The others were single cases of: oropharyngeal cancer, laryngeal cancer, laryngocutaneous fistula and tracheocutaneous fistula. The average hospital stay duration was 5,33 days, with only one patient staying longer than 6 days due to previous clinical comorbidities. There was no severe complication, such as total loss of the flap or death related to the procedure. Regarding the adverse outcomes, there was one case of partial loss of the skin of the donor site, which was covered with skin graft; one case of laringocutaneous fistula, with spontaneous closure on the 30th post-operative day; 2 cases of temporary orocutaneous fistula, with no need of additional interventions; and one had partial loss of the flap’s skin paddle. As for the functional outcomes, 10 patients have complete rehabilitation with no feeding tube or thracheotomy. Two patients have partial rehabilitation, one due to dysarthria, but with intelligible voice, and other with mild dyspnea due to reductant tissue but without tracheotomy. This last-mentioned patient is still on clinical evaluation of other causes of dyspnea. From this group, one patient died from a second primary tumor one year after the procedure.

Discussion: Most local flaps used for head and neck reconstruction are bulky, interfering negatively with functional outcomes on some cases, on the other hand, microsurgical free flaps demand a highly specialized team, carry expensive hospital costs and are not suitable for patients with major clinical comorbidities. Conversely, the infrahyoid flap is a thin and flexible myocutaneous local flap, which allows mobility of the preserved structures surrounding the defect, it is easy to harvest with minimal donor site morbidity, and does not require another surgical team.

Conclusions: The infrahyoid flap is a versatile and safe option for head and neck defects reconstruction. Our cases presented low rates of complications, with no total flap loss or major complications related to the procedure. The majority of the patients have complete functional rehabilitations and the remaining have minor functional impairment.