Poster Presentation New Zealand Association of Plastic Surgeons Annual Scientific Meeting

Are pedicled neck flaps more effective compared with free radial forearm flap in patients that underwent partial tongue resection and hemiglossectomy? (845)

Nadhira Anindita Ralena 1 , Parintosa Atmowidirjo 2
  1. Faculty of Medicine, University of Indonesia, Jakarta, DKI Jakarta, Indonesia
  2. Plastic and Reconstructive Surgery, Cipto Mangunkusumo Hospital, Jakarta, DKI Jakarta, Indonesia

In the past, there was a number of pedicled flaps commonly used, such as the infrahyoid myofascial, pectoralis major myocutaneous or the trapezius islandized pedicle flap. Over the time, more regional and free flap transfer were introduced to address the reconstruction of large head and neck defects. Free radial forearm flap has been a recommendation for patients with defect ≤ 50% because of its thinness, pliability and long pedicle. However, there are various current data discussing about the effectiveness of partial tongue resection and hemiglossectomy reconstruction using different types of pedicled flaps from the neck area. With these various sources, Writers wondered whether pedicled flaps from the neck region can be an alternative to free radial forearm flap, which has been the common reference. In order to compile all the available evidences, a literature searching was done using electronic databases with key words including pedicled flap, neck flap, partial tongue resection, hemiglossectomy, and partial neck surgery. Authors finally gathered 11 relevant articles. Overall, pedicled neck flaps, such as submental, infrahyoid, sternocleidomastoid, and supraclavicular artery island flap, have satisfactory cosmetic results for all patients, except for infrahyoid flaps performed in patients with advanced oropharyngeal squamous cells cancer stage 3 and 4 who had a wider resection of the tongue. Whereas, the sternocleidomastoid and submental muscle flap were considered to be more effective for repairing small to medium sized defects. Moreover, a research exhibited that pedicled supraclavicular artery flap could act as an alternative. Neck flaps would be a preferred technique in more difficult patients such as those with advanced age, poor nutrition, or multiple medical issues as they are not always acceptable surgical candidates for potentially prolonged microsurgery. Patients with clinically nodal enlargement from the underlying disease should not undergo the pedicled neck flaps.

  1. Amin A, Sakkary M, Khalil A, Rifaat M, Zayed S. The submental flap for oral cavity reconstruction: Extended indications and technical refinements. Head & Neck Oncology. 2011;3(1):51.
  2. Cossio P, Gonzalez-Cardero E, Lopez-Martos R, Nuñez-Vera V, Olmos-Juarez E, Ruiz-Moya A et al. Infrahyoid flap in oropharyngeal reconstruction following carcinoma resection: A study of 6 patients and literature review. Oncology Letters. 2016;11(5):3493-500.
  3. Golabek W, Kondratowicz J. Sternocleidomastoid myocutaneous flap for intraoral reconstruction. Eur Arch Otorhinolaryngol. 1990;247:379-81.
  4. Zhang S, Chen W, Cao G, Dong Z. Pedicled supraclavicular artery island flap versus free radial forearm flap for tongue reconstruction following hemiglossectomy. Journal of Craniofacial Surgery. 2015;26(6):527-30.