[10 years' experience on infrahyoid myocutaneous flap]

From May 1979 to December 1989, 260 infrahyoid myocutaneous flaps (IHMCFs) were used for reconstruction after resection of head and neck cancer in one stage. It has been certified that the IHMCF is a reliable versatile and convenient island myocutaneous flap, suitable for repairing the defect in the oral cavity, parotid region, oro- or hypopharynx particularly the tongue after hemi-excision of oral tongue to radical total glossectomy. The success rate of the IHMCF may be increased to 97% if the following points are noticed. 1. The sternal head of the sternocleidomastoid (SCM) muscle below the hyoid bone is included in the flap for protecting the platysma and the SCM branches of the superior thyroid artery to the IHMCF. 2. During cutting the tributaries of the internal jugular vein (IJV) below the level of the hyoid bone for increasing movability of the IHMCF, the cutting points must be near the anterior edge of IJV for preserving the communicating veins between the anterior jugular vein and IJV. 3. For reconstructing the oral tongue, the medial edge of the IHMCF must be designed 1 cm beyond that of the defect after partial excision of the oral tongue. Since the application of the IHMCF, the incidence of the tongue carcinoma patient (TCP) with T4 has increased from zero to 53%. The 5-year cure rate of the TCP with stage IV has raised from 11% to 42%. For N0 and N1 cases, the pure neck failure after modified neck dissection with preservation of lower 2/3 or whole length of the IJV was similar to that of the radical neck dissection.