Venous drainage of the platysma myocutaneous flap

The platysma myocutaneous flap offers a regional reconstruction option for relatively small soft tissue defects in the head and neck area. However, epidermolysis of its skin paddle with resultant fibrosis and tongue tethering has been documented. This has been attributed to arterial and/or venous vascular compromise. We investigated the venous drainage patterns of this flap in a cadaveric study.

We made selective Microfil dye injections into the external and internal jugular veins of 5 cadavers. A wide cervical flap was then raised, and anatomic dissection of the superficial and deep venous systems was performed to identify the dominant draining veins of the platysma flap.

Universally, small communicating veins from the internal jugular venous system were noted to drain the platysma flap anteriorly. The external jugular vein was noted to drain the flap posteriorly.

Although it is difficult to preserve the anterior communicating veins with 180 degrees flap rotation, the results of this study suggest a possible benefit of external jugular vein harvest in continuity with the platysma flap. Further clinical studies are needed to assess whether flap venous congestion, epidermolysis, and resultant fibrosis can be minimized with this technique.