This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on Web of Science (1)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Oncology  • Head & Neck Cancer  • Cancer Reconstruction of Head & Neck  • Neoplasms of Head & Neck  • Facial Plastic Surgery  • Alert me on articles by topic  Social Bookmarking   What's this?

Jacek Szudek, MD, PhD; S. Mark Taylor, MD

Arch Otolaryngol Head Neck Surg. 2007;133(7):655-661.

Objectives  To systematically review and quantify complication rates and to identify preoperative factors among patients who underwent platysma myocutaneous flap reconstruction for head and neck cancer.

Design  This study analyzed 190 patients in 16 case series published between 1982 and 2002. Funnel plots, contingency tables, and ² analyses were used to minimize bias and heterogeneity among the studies. Logistic regression models were used to quantify the associations between preoperative factors (age, sex, T stage, prior radiation therapy, and recipient site) and complications (skin loss or necrosis, fistula, dehiscence, hematoma, and infection) at different recipient sites (floor of mouth, alveolar ridge, pharyngeal wall, buccal mucosa, tongue or tongue base, and tonsil).

Setting  Academic research.

Patients  Patients described in the literature with head and neck surgery who underwent platysma flap reconstruction.

Main Outcome Measures  Results of logistic regression analyses.

Results  Seventy-one patients (37%) developed a complication, ranging from 20% at the buccal mucosa to 55% at the tonsil and at the alveolar ridge. Major complications (ie, those requiring further surgery) occurred in 5% of patients. The most common complication was skin loss or necrosis, occurring in 25% of patients. Postoperative complications were not associated with age or sex but were associated with recipient site and tumor stage. Overall, complications were 0.3 (95% confidence interval [CI], 0.1-1.1) times less common at the buccal mucosa than at other recipient sites. Hematomas were 18.8 (95% CI, 1.6-217) times more common at the buccal mucosa. Infections were 20.0 (95% CI, 1.1-350) times more common at the pharyngeal wall. Major complications were 4.6 (95% CI, 0.9-23.5) times more likely, and fistulas were 9.2 (95% CI, 2.0-43.1) times more likely in patients with stage T3 or T4 oral cancer than in patients with lesser grades.

Conclusions  Postoperative complications were not associated with age, sex, or preoperative radiation therapy, but they were associated with recipient site and tumor stage. These results may guide surgeons considering the platysma flap to reconstruct head and neck cancer.

Author Affiliations: Division of Otolaryngology, University of Alberta, Edmonton (Dr Szudek), and Division of Otolaryngology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada (Dr Taylor).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?