Oncoplastic surgery for cutaneous head and neck cancers: A novel technique combining wide excision, local flap...

Sentinel node biopsy (SNB) procedures in the head and neck (H&N) region can be technically demanding due to anatomic and size constraints. Often, node procurement is attempted through small incisions, making identification of crucial anatomy difficult. Given the primary site may be close to the sentinel nodes (SN), a local flap can be designed for the dual purpose of gaining access to the sentinel node field through raising the flap while facilitating repair of the primary site resulting in superior aesthetic outcomes. We detail our technique hereof.

A review of consecutive patients undergoing surgery for cutaneous head and neck malignancies between July 2021 and December 2023 was undertaken. Patients, who had undergone a local flap reconstruction in the H&N region, through which the SNs were procured, were included in the study.

A total of 20 patients were identified, of whom eighteen had melanoma and two had Merkel cell carcinoma, located on the scalp, face and neck in which lymphoscintigraphy (LSG) identified unilateral drainage, with a median of three SNs (range 1-5), at a median of two levels (range 1-3) in the neck per patient. A median excision margin of 1.5 cm (range 1-2 cm) and a local flap alone was used in 19 (95 %) patients for SN procurement.

This novel technique of procuring the SNs through the local flap incisions offers an excellent anatomical visualization and safe procurement of SNs with low complication rates while offering good aesthetic reconstructive outcomes.