Infrahyoid flap revisited - A head and neck surgical perspective in the Indian setting

In India, head and neck cancer contributes to about 35% of all malignancies. Among head and neck squamous cell cancers, buccal mucosa and tongue are the most common subsites. Reconstruction of defects after resection of primary in these subsites with acceptable cosmetic and functional outcomes remains a challenging task. In the era of free flaps, many pedicled flaps are being overlooked. Infrahyoid flap (IHF) is one among them. This study discusses the feasibility of IHF in reconstruction of small and medium-sized defects in subsites of the oral cavity.

This study is a retrospective analysis of 23 patients who underwent IHF and reconstruction after excision of primary in a case of oral cavity squamous cell carcinoma from January 2010 till November 2017 with a median follow-up of 15 months. Patients who were diagnosed as a case of squamous cell carcinoma in oral cavity subsites (T1-T3 and N0/N1-N2) and in whom the anticipated defect size was small to medium were included. The evaluation was then done based on the possibility to reach recipient site, vitality after transposition, definitive integration, and clinical outcome.

Out of 23 patients, 5 patients had flap-related complications of which 1 patient had total skin paddle necrosis and 4 patients had partial skin paddle necrosis at distal end. However, no patient developed oro-cutaneous fistula or required corrective surgery. The maximum flap dimension was 9 × 4 cm and average flap dimension was 6 × 4 cm. The postoperative outcome of all patients remained uneventful.

The infrahyoid myocutaneous flap is a reliable and convenient flap which can be used as a good alternative for free flaps in small and medium-sized defects of the oral cavity.