Usos del colgajo dermoplatismal en faringolaringectomía

Abstract

Introduction and objective: Reconstruction of the primary defect is an essential component of the surgical treatment of head and neck cancer. The myocutaneous platysma flap was introduced in 1978. However, despite its numerous advantages, it was first overshadowed by the pectoralis major flap (Ariyan, 1979) and later by microvascular free flaps.

Method: We present the cases of four patients who underwent surgery in our service in which the myocutaneous platysmal flap was performed for reconstruction.

Results: CASE 1: A 70-year-old male, undergoing ENT follow-up for right hypopharyngeal squamous cell carcinoma treated with radical radiotherapy, with local persistence. Hypopharyngoscopy with biopsy revealed the presence of infiltrating squamous cell carcinoma in the region of the three right folds that extended to the anterior, internal, and antero-external slopes of the ipsilateral piriform sinus. Total laryngectomy with right partial pharyngectomy and left myocutaneous platysmal flap was performed in November 2020.

CASE 2: A 69-year-old male with a history of squamous cell carcinoma of the pharynx who underwent surgery in 2015 and squamous cell carcinoma of the pharynx treated with RT+CT. In 2021, there was evidence of recurrence of squamous cell carcinoma of the left tongue base, and in February 2021 a left partial pharyngectomy was performed with resection of the tongue base and reconstruction with a myocutaneous platysmal flap.

CASE 3: A 54-year-old male presented with an infiltrating tumor in the left supraglottic region that infiltrated the base of the left tongue, vallecula, left pharyngoepiglottic fold, superior constrictor muscle, and left tonsillar fossa, externalizing through the thyrohyoid membrane and infiltrating the internal jugular vein. He underwent surgery in June 2021 for an extended total tongue-based laryngectomy with an extended left tonsillectomy and a right myocutaneous platysmal flap.

CASE 4: A 59-year-old male with squamous cell carcinoma of the oropharynx treated with RT+CT in 2021. He presents with persistence of the pharynx and pathological right and left adenopathies despite treatment, so in May 2022 he undergoes subtotal glossectomy, left oropharyngectomy, and total right parotidectomy, right radical neck dissection and left functional neck dissection, with reconstruction with left myocutaneous platysmal flap and right pectoralis major flap.

Discussion and conclusions: The advantages of the myocutaneous platysmal flap include ease of access to the donor site as it is in the same surgical field, minimal morbidity and ease of primary closure of the donor site, as well as the appropriate size of the flap for most defects (up to 70cm2). It has been shown to be a useful alternative in the closure of head and neck defects and should be part of the therapeutic arsenal of any head and neck surgeon working in the field of oncology.