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Use of apron flap incision for neck dissection
N W Yii1, S G Patel, P Williamson
1Head and Neck Unit at Royal Marsden Hospital, London, United Kingdom.
Plastic and Reconstructive Surgery
|May 14, 1999
Summary
The apron flap incision showed no wound dehiscence in head and neck cancer surgery, unlike triradiate and modified MacFee incisions. This approach is recommended, especially for patients with prior neck irradiation.
Area of Science:
- Surgical Oncology
- Head and Neck Surgery
- Plastic and Reconstructive Surgery
Background:
- Neck dissection is a critical surgical procedure for head and neck cancer management.
- Various skin incisions are utilized, each with potential complications.
- Wound dehiscence is a significant concern impacting patient recovery and outcomes.
Purpose of the Study:
- To compare the incidence of wound dehiscence among three common neck dissection incisions: triradiate, modified MacFee, and apron flap.
- To evaluate the impact of previous neck irradiation on wound healing across different incision types.
- To identify the optimal incision for minimizing postoperative complications, particularly in irradiated necks.
Main Methods:
- A retrospective review of 166 patients undergoing 184 neck dissections.
- Classification of incisions into triradiate (n=85), modified MacFee (n=25), and apron flap (n=74).
- Statistical analysis to compare wound dehiscence rates and other complications between incision groups and in relation to prior irradiation.
Main Results:
- The apron flap incision had a 0% incidence of wound dehiscence, compared to 11% for triradiate and 8% for modified MacFee.
- A statistically significant reduction in wound dehiscence was observed with the apron flap compared to the triradiate incision (p=0.004).
- Previously irradiated necks showed a higher overall incidence of wound dehiscence (p=0.02), significantly linked to the triradiate incision (p=0.005).
- No significant differences were found in other complications like seroma, hematoma, infection, or fistula formation among the incision types.
Conclusions:
- The apron flap incision is associated with the lowest rate of wound dehiscence in neck dissections.
- This incision is particularly advantageous for patients with a history of neck irradiation, offering easier access and superior wound healing.
- The apron flap's robust vascular supply and lack of a trifurcate point contribute to its favorable outcomes.