The platysma myocutaneous flap: Underused alternative for head and neck reconstruction

Objectives: The use, advantages, and disadvantages of the platysma flap were assessed. Study Design: Retrospective review of the medical records of patients undergoing platysma flap reconstruction of the upper aerodigestive tract from 1987 to 2001. Methods: Information regarding the tumor, surgical procedure, flap design, and outcome emphasizing complications and function was extracted. Associations between putative risk factors for flap failure and outcome were assessed using the χ² test. Results: Thirty-four patients underwent reconstruction with platysma flaps. Surgical defects included the oropharynx, oral cavity, and hypopharynx. Nine patients had had prior radiation therapy and all had some dissection of the ipsilateral neck. There were 5 postoperative fistulas (15%), flap desquamation was noted in 6 cases (18%), and 2 patients experienced loss of the distal skin closing the donor site. Complications were not associated with prior radiation. Hospital stay ranged from 5 to 21 days (mean, 10 d). There were no returns to the operating room or need for additional reconstruction. All but 1 patient resumed a normal diet within 3 months of surgery. There were no recurrences of cancer in the dissected neck regions. Conclusions: The platysma flap is simple and versatile with properties similar to the radial forearm free flap. The rate of complications is similar to other published series, and problems encountered were manageable using conservative methods with excellent functional and cosmetic outcomes. These facts support the contention that the platysma myocutaneous flap can serve as a viable alternative to free tissue transfer and has advantages over pectoralis major pedicled flaps for reconstruction of many head and neck defects.