Platysma Flap: An Alternative to Free Flaps

Abstract

The platysma flap is a good method to reconstruct small and medium sized defects of oral cavity, especially in patients where a microsurgery reconstruction is not possible.

Platysma myocutaneous flap revised in the free flaps era: clinical experience in 61 patients

“…The platysma is a thin quadrangular-shaped muscle that lies in the superficial fascia of the neck. The muscle fibres arise from the superficial fascia of the pectoralis major and deltoid muscles, cross the clavicle and run obliquely inserting at the angle of the mandible, inferior part of the cheek, and depressor muscles of the lip [1][2][3][4][5][6][7][8][16][17][18][19][20][21] . The main artery supplying the platysma is the submental branch of the facial artery 3,4 .…”

“…Considering the main vascular pedicle, two different variants of MPF can be harvested for head and neck reconstruction: the posterior flap based on branches of the occipital artery and the superior or vertical flap based on the submental branch of facial artery; the latter has the widest diffusion in surgical practice [2][3][4] . MPF has applications in reconstructing a large variety of head and neck defects and, in particular, has shown to be a good surgical option for the reconstruction of small to medium, and, rarely, large sized (15-75 cm 2 ) mucosal defects of the oral cavity [1][2][3][4][5][6][7][8][16][17][18][19][20][21] . The thinness and pliability of the muscle-skin paddle unit make the platysma flap particularly suitable for tailoring defects of floor of the mouth, cheek mucosa, and gum to prevent post-operative functional impairment, due to primary closure with excessive tension 1,2 .…”

“…The thinness and pliability of the muscle-skin paddle unit make the platysma flap particularly suitable for tailoring defects of floor of the mouth, cheek mucosa, and gum to prevent post-operative functional impairment, due to primary closure with excessive tension 1,2 . According to the literature, other sites suitable for reconstruction with MPF are the lip, lateral wall of the oro-hypopharynx, and low facial skin defects [1][2][3][4][5][6][7][8][16][17][18][19][20][21] . When compared to other flaps such as the ALTFF, RFFF, and pectoralis major myocutaneous pedicle flap, the MPF is less bulky, with better skin colour match; the time for harvesting is shorter, and donor site morbidity is lower 2,3 .…”

“…Reconstruction of oral cavity defects following radical surgery for SCC can be achieved by a variety of techniques [1][2][3][4][5][6] . The choice is influenced by several factors, including size and location of the defect, patient characteristics, donor site morbidity, and functional and aesthetic outcomes [1][2][3][4][5][6][7][8][9][10][11][12][13] . Nowadays microvascular free flaps, for instance anterolateral tight (ALTFF) and radial forearm (RFFF), are considered the gold standard among head and neck surgeons for restoration of oral defects.…”

“…Furthermore, donor site morbidity is low, and it is easy to access in the same operative field, reducing the operation time [1][2][3][4][5] . Consequently, MPF can be an excellent choice in reconstruction of oral cavity, oropharynx, and low face defects of small to medium size (15-75 cm 2 ) [1][2][3][4][5][6][7][8] ; however, some anatomical and oncological controversies on the use of this flap are still debated. In particular, several authors have stated that it is difficult to perform a safe oncological neck dissection and at the same time preserve effective vascularisation of the flap [7][8][9][10][11][12] .…”