Modified Infrahyoid Myocutaneous Flap: A Systematic Review of Surgical Techniques

The infrahyoid myocutaneous flap (IHF) is used in reconstructive procedures for small- and medium-sized defects of the head and neck. The IHF is a versatile and technically straightforward reconstructive option; however, it has several limitations, including less reliable skin-paddle vascularity, size constraints, and a relatively short pedicle length. Accordingly, modifications aimed at improving its reliability and versatility have been actively explored. This systematic review aimed to identify available modifications of the IHF, with a focus on surgical technique. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided search from 1986 to 2025 identified 22 studies encompassing 728 patients. The modifications were categorized into five groups: incision modification, pedicle modification, superficial vein preservation, inclusion of the thyroid gland in the flap, and combination with a microvascular procedure. Among these groups, pedicle modification by periosteal release of the strap muscles from the hyoid was the most commonly used technique. These modifications can also be combined. The pooled estimates for overall flap loss with periosteal release of the strap muscles from the hyoid and vein preservation were 1.66% and 1.62%, respectively. The surgical techniques in each group are highlighted and discussed in this review. Overall, reconstructions using a modified IHF showed improved reliability and may broaden the clinical applications of this flap. However, conclusions regarding the ideal modification cannot be drawn because comparative studies are lacking.