[Analysis of 27 cases of defect restoration using infrahyoid myocutaneous flap after intraoral cancer surgery].

Objective: To compare different surgical techniques and clinical effectiveness using infrahyoid myocutaneous flap to restore effects after intraoral cancer surgery.

Methods: It is a retrospective study in Sichuan cancer hospital, from May 1994 to March 2007, 27 cases were treated surgically with unilateral infrahyoid myocutaneous flap, 19 males and 8 females. Seven cases of squamous cell tongue carcinoma, 4 cases of tongue root carcinoma, 16 cases of mouth floor carcinoma. The biggest flap was 4 cm x 8 cm. In 8 cases, the flap was formed since the remote end reverse vascular traveling and carried with inferior 1/3 muscular tissue of the sternocleidomastoid muscle on the same side (retrograde flap forming), in 19 cases, vascular pedicle was anatomies with microscopic blood vessel-operating skills along vascular traveling before the flap forming (anterograde flap forming). Eleven cases of the reservation vascularized and infrahyoid muscles in the hyoid attachment (combination pedicle), in 16 cases, the arteria and vena thyroidea superior reserved as the pedicle accompanied with the vena jugularis anterior (the axial vessel pedicle); in 21 cases, the distal end of the vena jugularis interna was tied up at the place where the vena facialis communis joins to the vena jugularis interna. and the vena jugularis anterior was reserved within the flap (interference return).

Results: The survival rate of total 27 cases are 77.8%. The flap necrosis in two cases of total group, 1/3 - 1/2 skin necrosis of the flap was found in 4 cases, in the six cases, flap was formed with retrograde flap forming carry with the ipsilateral sternocleidomastoid, the reason of necrosis was venous flow obstruction. Twenty-one flaps of interference return are all survived, the flap in 19 cases with anterograde flap forming all survived, and 16 cases of the axial infrahyoid flap all survived. Follow-up nine months to 13 years with a median follow-up time for four years. Lost four cases, 23 followed up cases did not found on the flap recurrence of cancer. The primary tumor recurrence in three cases, six cases of cervical lymph node recurrence, Kaplan-Meier method statistics 3, 5-year survival rates were 69.8%, 47.2%, respectively.

Conclusions: To improve the survival rate, the surgical approach of anterograde flap forming is suitable, to anatomies the axial vessel pedicle with microscopic skills, in particular should pay attention to ensure that venous return. Carrying with the same side of the sternocleidomastoid muscle tissue and retaining hyoid attachment of infrahyoid muscles will not increase the survival rate of the muscle flap.