H incision--method of choice for radical neck dissection

Area of Science:

• Anatomy
• Surgical Oncology
• Vascular Surgery

Background:

• Radical neck dissection (RND) carries risks of skin necrosis, fistula formation, and carotid artery rupture due to compromised neck skin vascularization.
• Understanding the arterial supply to the neck's skin is crucial for optimizing surgical approaches and preventing postoperative complications.

Purpose of the Study:

• To investigate the vascularization of the neck skin to inform the design of surgical incisions for RND.
• To propose an optimal incision technique that preserves blood supply and reduces surgical site complications.

Main Methods:

• Cadaveric dissection with colored media injection to visualize neck cutaneous arteries.
• Application of the Spalteholz method for clearing tissue specimens.
• Analysis of arterial pathways and density in the neck skin.
• Review of wound healing outcomes in 184 patients undergoing RND with the proposed H-incision.

Main Results:

• Neck cutaneous arteries generally follow a longitudinal course, with descending branches from the external carotid and ascending branches from the subclavian artery.
• A region of relatively poor vascularization was identified in the middle of the neck.
• The proposed H-shaped or three-quarter H incision strategically traverses this less vascularized area, preserving major vessels.
• Wound healing results from 184 patients demonstrated successful outcomes using the H-incision technique.

Conclusions:

• The H-shaped incision, based on detailed anatomical vascular mapping, is superior for RND as it avoids critical blood vessels.
• This anatomical insight allows for surgical planning that minimizes the risk of skin necrosis and other serious complications after RND.
• The H-incision technique has shown positive clinical results in a significant patient cohort.