How i do it: Head and neck and plastic surgery: Platysma myocutaneous flap: Caveats reexamined

Complications of the myocutaneous platysma flap in intraoral reconstruction

“…However, reports of anatomic studies 14,15 describe that an intact facial artery is not necessary for the survival of the flap. Some authors describe series of platysma flaps in which they routinely perform a radical neck dissection with ligation of the facial artery 4,6 with low complication rates. Nevertheless, we prefer not to jeopardize the vascularization and favor the use of other flaps in cases where the artery cannot be spared.…”

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) .…”

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

“…There are controversies concerning the preservation of the facial artery with PTMCF during neck dissection. Some reports [4,7,8,13,14] emphasize that PTMCF cannot be combined with standard neck dissection because the nutrient facial artery is divided proximal to its submental branch, while others [3,5,6,9,15,16] support the combination of neck dissection with ligation or severing the facial artery since there are no unexpected complications probably because the contralateral blood supply remains intact. Our version allowed several kinds of neck dissection to be combined with PTMCF.…”

“…Similar cervical island flaps, possibly with a random pattern, were previously reported by Edgerton and Desprez [2] and Farr et al [3] without consideration of the musculocutaneous perforator. Following these clinical experiences, the vascular supply of PTMCF has been precisely reported since 1983 [4][5][6]. It was found that the PTMCF derives its arterial blood supply predominantly from the submental branch of the facial artery [4].…”

“…Therefore, it has been reported that the reliable PTMCF should not be used in standard neck dissection because the facial artery is divided proximally to its submental branch [7,8]. Even though ligating the facial artery causes the loss of all or part of the flap in about 40% of cases [9], there were no complications that could not be managed arising from the use of the PTMCF [6]. Since 1973, we have used a modified Farr's cervical island skin flap for 50 patients, and the facial artery was severed in 46 patients [10,11].…”