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SYSTEMIC REWIEW OF THE PLATYSMA MYOCUTANEOUS FLAP FOR HEAD AND NECK RECONSTRUCTION PLATYSMA MYOCUTANEOUS FLAP Introduced by Futrell et al in 1978 Myocutaneous axial distant flap Origin: Upper part of pectoral and deltoid fasciae Fibres run upwards and medially Insertion: Anterior fibres: base of mandible Posterior fibres: to the skin of lower face and lip Potential design of platysma flap: Superiorly based flap with arterial blood supply from the submental branch of facial artery Posteriorly based flap with arterial supply from occipital and posterior auricular artery Inferior based flap with arterial supply from transverse cervical artery Superiorly based flap: useful for reconstruction of anterior oral defects Floor of mouth Labial mucosa Buccal mucosa Alveolar ridge Portion of lip or chin Posteriorly based flap: best suited for posterior oral mucosal or ridge defects Lower third of face Posteriorly Based Platysma Flap Superiorly Based Platysma Flap Good venous drainage through external jugular vein Poor venous drainage through submental vein Collaterals of the superior thyroid artery and occipital artery provide axial pattern blood supply at the anterior border of the sternocleidomastoid muscle Good arterial blood supply through submental branch of facial artery Denervated muscle Muscle may be elevated, preserving motor innervation by cervical branch of seventh cranial nerve Arc of rotation allows for reconstruction of lower lip, anterior and lateral floor of mouth, ventral surface of tongue, and skin of lower third of the anterior face Arc of rotation allows for reconstruction of anterior and lateral floor of mouth, buccal mucosa, retromolar trigon, and skin of the lower third of the cheek and parotid region posteriorly based platysma myocutaneous flap. superiorly based platysma myocutaneous flap. Superiorly based platysma myocutaneous flap Posteriorly based platysma myocutaneous flap Surgical technique: Advantages: Easy to harvest , thin , and pliable Large enough to close upto 70 cm2 Low donar site morbidity Functional impairment of deglutition, speech and denture fitting is minimal Cervical skin defect is closed primarily along with the neck incision , resulting in little or no cosmetic defomity Disadvantages: Blood supply can be unreliable When based on submental artery , this requires preservation of muscularity in an area of oncological significance which may have to be addressed in the resection Lack of bulk Removal of the platysma interferes with the blood supply to the overlying skin , which can have disatrous results High rate of complications Reported contraindications: Preoperative radiation Ipsilateral facial nerve paralysis Prior radical neck dissection Ligation of the facial artery Complications: Partial or total flap loss Fistula Wound dehiscence Haematoma Infection Dale A. Baur, et al (J Oral Maxillofac Surg, 2002) studied 7 patients with posteriorly based platysma flap used in reconstruction for various tumor resection defects of the oral and facial region. Three of the patients (43%)in this study had no complications. Three patients (43%)had some skin sloughing, but the underlying muscle remained viable and mucosalized normally. One patient (14%) had 40% flap loss of the distal end, possibly due to vascular compromise that occurred during aconcomitant neck dissection. Nikolaos Lazaridis, et al (J Oral Maxillofac Surg, 2007) studied the reliability and use of the superiorly based platysma flap for reconstruction of small and medium oral defects in 5 patients Three patients (60%) had some skin sloughing in the recipient site. None of the patients had complications in the donor site. Deborah et al (Am J Surg June 1993) Retrospective analysis of 41 patients from 1980-1990 Pre or post operative radiotherapy (39%) & preoperative chemotherapy (73%) Flap related complications occurred in 8 patients (19%) These included partial flap necrosis, skin necrosis of the neck suture line, and fistula formation These results indicate that the platysma flap is a viable alternate in reconstruction