MacFee incisions: dispelling the myth of cervical flap vascular inadequacy

MacFee (double horizontal) incisions have often been criticized for transecting the dominant blood supply of the central bipedicled cervical flap. To assess the viability of this flap we reviewed our recent surgical data. Ninety-three patients who underwent 100 radical neck dissections were evaluated retrospectively for cervical skin viability after surgery. MacFee incisions were used in 50 of these; in the remaining 50 a variety of other incisions were used. With MacFee incisions no ischemic tissue loss resulted. By contrast, six patients (12%) in the comparison group experienced partial flap necrosis due to ischemia. Chi-square analysis shows this difference to be statistically significant (P less than 0.01). This study shows the bipedicled cervical flap to be durable, dependable, and sufficiently vascularized to prevent ischemic tissue loss, even when incisions were previously placed in the ipsilateral neck or antecedent radiation therapy was delivered.