Single transverse incision for neck dissection in head and neck cancer: Impact on cosmetic and functional outcomes

Skin-incision design in neck dissection for head and neck cancer may influence operative exposure, wound healing, scar appearance, and postoperative function. This study compared the surgical, oncologic, cosmetic, and functional outcomes of a single transverse incision with those of conventional neck-dissection incisions in patients with head and neck cancer.

This retrospective study included 172 patients with head and neck cancer who underwent unilateral neck dissection. Among them, 81 underwent neck dissection through a single transverse incision, and 91 underwent neck dissection through other incision types, including hockey-stick, modified Schobinger, and apron incisions. Surgical outcomes were assessed according to operative time, lymph node yield, complications, and recurrence. Cosmetic outcomes were evaluated using the Self-Assessment Questionnaire for Cosmetic Outcomes (SAQCO) and Vancouver Scar Scale (VSS). Functional outcomes, including neck edema, discomfort, fibrosis, sensory loss, and neck and shoulder movement, were compared between groups. Propensity score matching was performed using five covariates: age, sex, primary tumor site, extent of neck dissection, and TNM stage.

Operative time, lymph node yield, complication rates, and recurrence rates did not differ significantly between the groups. The single transverse incision group showed significantly better VSS scores, cosmetic satisfaction, neck discomfort, and neck fibrosis. Propensity score matching generated two matched cohorts of 44 patients each. In the matched analysis, lymph node yield, complications, and recurrence rates remained comparable between groups.

The single transverse incision provided superior cosmetic and selected functional outcomes while maintaining surgical and oncologic outcomes comparable to those of conventional neck-dissection incisions.