J incision in neck dissections

Abstract

Metastasis in the neck lymph system of primary tumours of the head and neck is frequently seen. In order to prevent this metastasis, neck dissection is carried out by various types of skin incisions. In this study, types of skin incision used in neck dissections were defined, and the advantages, disadvantages and results of J incisions, which have been performed on 320 radical neck dissection patients in our clinic between 1985–1996, were compared with those of other incision types.

Functional Results of Transverse Extended Incision in Cervical Neck Dissection

“…From the initial works presented by Ellis 17 and Stell, 18 who described failures in the wound primary closure of 79% and 55% of the cases, respectively, several series report similar results, with the posterior flap and the trifurcation area being the most frequent sites of necrosis and dehiscence, leading to an increased risk of carotid exposure and blowout. 19 Acar et al, 20 in a series in which included 320 patients who had undergone a J incision, described a dehiscence rate of 12.6%, a rate of apron flap necrosis of 3.3%, and contracture at the cervical level in up to 3% of cases. A recent study published by Guillier et al compares the use of the Paul-André, or J incision, with the transverse incision, with the perception regarding the aesthetic result by the surgeon and patient satisfaction between both groups being the only statistically significant parameters, in both cases in favors of the transverse incision group.…”

Oral Squamous Cell Carcinoma

“…[43][44][45][46] The simple cervical and modified Schobinger incisions are the workhorse for selective and comprehensive neck dissections, respectively (Table 53-4). Over the years, surgeons have created various neck incisions designed to achieve a balance between flap viability, carotid artery protection, planned tracheostomy, resurfacing, cosmesis, and surgical exposure.…”

Single Supraclavicular Transverse Incision for Radical Neck Dissections

“…The most common procedure is Mac Fee radical neck dissection, which is usually performed through an extended collar incision 3 cm above the clavicle extending to the posterior edge of the sternocleidomastoid muscle, combined with a second parallel transverse middle neck incision (1). Other neck approach options are unaesthetic vertical incisions, such as Hayes Martin and J incisions, which provide excellent surgical exposure at the expense of crossing Langer's tension lines, and may cause scar hypertrophy and stretching, and can lead to flap necrosis owing to ischemia (2)(3)(4)(5)(6)(7)(8). Any incision must afford the surgeon the flexibility to change the course of the operation, depending on the intraoperative findings, while allowing for optimal exposure of the operative site, as well as enable a rapid, safe, and oncologically complete procedure, whenever possible, with good aesthetic results (9,10).…”