Modified Infrahyoid Myocutaneous Flap for Laryngopharyngeal Reconstruction

Abstract

The laryngopharyngeal reconstruction in patients with pyriform sinus carcinoma continues to be a challenge for surgeons. In this article, we describe our experience with laryngopharyngeal reconstruction in patients with pyriform sinus carcinoma using the modified infrahyoid myocutaneous flap (IHMCF). The modified incision design for the modified IHMCF and clinical outcomes are also detailed here. Between January 2012 and February 2018, 10 patients with hypopharyngeal squamous cell carcinoma who underwent laryngopharyngeal reconstruction using the modified IHMCF after hemicricolaryngopharyngectomy were included in this study. The drainage vessels of the modified IHMCF, oncological outcomes, and functional reservation of the larynx were recorded. All of the flaps survived well. No flap necrosis or other major complications occurred during follow-up. None of the patients remained on nasogastric feeding for more than 4 weeks postoperatively. The follow-up period ranged from 12 to 73 months (mean, 36 months). In our series, 6 patients were successfully decannulated and 5 had received radiation therapy. We roughly assessed the speech and swallowing functions, and the outcomes seemed acceptable in all of the patients after surgery. Laryngoscopic examination showed that the modified IHMCF survived well and the new glottis provided excellent function and good ventilation results. In our experience, the modified IHMCF is a safe and viable procedure that can serve as a valid alternative to free flaps and the pectoralis major myocutaneous flap to reconstruct laryngopharyngeal defects.

Reconceptualizing the Application of Infrahyoid Flap in the Era of Free Flaps in a Developing Country

“…15,16 Neither is any microsurgical expertise or instruments nor a second team to harvest the flap required, also it is a one-step procedure all of these contributing drastically to cutting down the cost of surgery. 13,14 Deganello et al, in their study have also shown great economic benefits with neck flaps when compared to free flaps. 18 The mean discharge time in our study was just seven days post-surgery.…”

“…Since the infrahyoid flap was close to the recipient site there are no additional scars on the neck. 11, 12, 14, 15 It was well accepted by the patients since the donor site was also in the vicinity of the recipient site. 13, 16 The distress and recovery at the infrahyoid donor site were quite negligible when compared to free flaps as they can be closed by primary intention with Z-plasty as and when required.…”

New techniques in harvesting of fasciomyocutaneus infrahyoid flap to reconstruct larger defects of advanced oral tongue cancer(T3 & T4a)

“…(1,3,4) However, like other regional flaps and free flaps, there are concerns such as partial or incomplete flap failure and subsequent flap necrosis, about this flap as well as excessive flap volume hypotrophy. (5)(6)(7)(8) On the other hand, the most important limitation of the infrahyoid flap is its low bulk, which makes it not suitable for more advanced tumors that are accompanied by simultaneous resection of more than 50% of the anterior tongue and nearly 50% of the base of the tongue. The small size of this flap leads to swallowing and Speech problems and aspiration are used in the reconstruction of extensive tounge defects.…”