Extended approach in head and neck tumors: modified Schobinger incision

Surgical treatment of many tumors of the head and neck require extended approaches. Many cervicotomies have been described in the treatment of head and neck and cervical tumors; careful thought must be made by a surgeon when surgical treatment is planned for an extended tumor.Our purpose is to show the versatility of the modified Schobinger incision. Between 2003 and 2005, 18 patients were operated on at our plastic surgery department; all presented extended cervical tumors of various origins.In all 18 patients, a Schobinger incision as modified by Yoel and Linares was used. The principal modification described by these authors consisted in the extension of the vertical line of incision below the subclavicular area to the nipple-areola complex. Partial necrosis occurred in two (11%) patients; one (1.8%) patient developed a pharyngocervical fistula; in all cases, healing occurred spontaneously. The benefits of this incision are as follows: 1) an unobstructed vision of anatomic landmarks and the more distal surgical elements; 2) increased blood supply for the flap by means of recruitment of new arterial vessels from the first, second, third, and fourth internal mammary perforators; 4) should flap necrosis occur, it will not compromise the coverage of the great vessels of the neck; 5) the flap's excessive mobility permits it to be used in facial areas, thus facilitating their reconstruction. Other advantages of this incision are that it permits access to different areas of the surgical field, that it allows protection of vital anatomic structures in both the pre- and postoperative periods, and that it results in an inconspicuous and aesthetically acceptable final scar.