Defatting the neck through direct excision aesthetic. The lateral intercostal artery perforator licap flap for outpatient total breast reconstruction lee squitieri md, ms1, cloe hakakian bs2, joshua d. If a standard aprontype flap is raised for a neck dissection, the inferior margin of that flap will be the inferior margin of the platysma flap. Modern facelift surgery was initiated by skoog, who elevated a cervicofacial flap deep to the platysma and the superficial fascia of the face.
The advantages of this flap are the proximity to the surgical area, and the fact that the skin island pedicled by platysma muscle is easily harvested and transplanted to the defect. The flap controller is designed to work within the boundaries dictated by the dynamics of the aircraft. Inferior mandible at symphysis, skin of lower face action. In addition to the simplicity of the procedure, it has other advantages over medial plication of the muscle, because. Desprez and kiehn 1959 reported the modified apron flap, which included the platysma muscle. Platysma myocutaneous flap its current role in reconstructive surgery of oral soft tissue defects 5 skin paddle up to the mandible, leaving the platysma down. The platysma flap has often been used for reconstructions of the head and neck, but the arterial anatomy of the platysma itself has not been clarified. The outline of the platysma flap is initially made as an. The platysma muscle is one of a pair of platelike, wide muscles at the side of the neck. Before flap harvesting the anticipated intraoral defect is measured. A platysmaplasty is an operation of the muscle of the neck called the platysma. Contusion of the platysma could be a sign of choking or strangulation.
Research open access vertical platysma myocutaneous. The smas and platysma flaps can be rotated in the postauricular area to. Pdf reconstruction of oral softtissue defects following resection of oral carcinomas can. The posterosuperiorly based platysmal myocutaneous flap. It is a versatile, portable, and thin flap, is easy to perform, and can be obtained during neck dissection, with a primary closure of the donor site. The platysmal myocutaneous flap has shown promising. Then i completely excise the rest of the fat on the neck and on the. Use of a platysma myocutaneous flap for the reimplantation. Many surgical procedures have been described for the correction of the depressed, fixed posttracheostomy scar, which produces a tracheal tug during swallowing. We report on our experience with using a distally based island flap for soft tissue reconstruction of the foot in limb salvage surgery for malignant melanoma patients. Pdf vertical platysma myocutaneous flap reconstruction. The platysma myocutaneous flap for intraoral reconstruction was introduced in 1978.
In cases in which the surgical defect is small and the options for free flap use are limited, the platysma myocutaneous flap is. The platysma myocutaneous flap for oral cavity reconstruction kevin h. Atlas of muscle and musculocutaneous flaps globalhelp publication. Moving anterior to posterior, the muscle is anchored to the mentum and the inferior mandibular border and meets the orbicularis oris laterally and then the depressor anguli oris. Pedicled flaps in head and neck surgery slideshare. Typically a platysmaplasty is used to treat a sagging neck, also known as a turkey wattle. The goals of facial reconstruction center on closing defects in an inconspicuous manner. This chapter presents the technique, current concepts, complications, and indications of. The arc of rotation is suitable for reconstruction of the lower lip, floor of mouth, ventral tongue, and lower one third of the face. The platysma myocutaneous flap for oral cavity reconstruction. The platysma myocutaneous flap dates back to 1887 when an austrian surgeon, robert gersuny, described repair of a cheek defect.
Knowledge of the surgical anatomy and the landmarks to find the facial nerve are the key to preserving facial nerve function. Rejuvenation of the aging neck is approached with varying techniques designed to correct undesired contours of the neck and cervicomental angle cma. Fascia of superior portions of pectoralis major and deltoideus insertion. Platysma myocutaneous flap for intraoral reconstruction j. An anterior flap is elevated superficial to the greater auricular nerve and the parotid fascia. Surgical management of oral submucous fibrosis osmf. Wrinkle neck skin, depress corners of mouth, depress mandible greek etymology guess. Platysma myocutaneous flap its current role in reconstructive. The platysma myocutaneous flap was introduced for intraoral reconstruction in 1978. With this method, the platysma is tightened in an upward direction bringing it close to the chin fig. It is a broad sheet arising from the fascia covering the upper parts of the pectoralis major and deltoid.
Yet, it was only introduced to the english literature in 1978 by futrell et al, 1 and since then, it has become established as an attractive reconstructive alternative with several potential advantages. The suture technique resembles the ties in a corset as one side is sewn to the other. The aim of the study is to present our experience using vertical pmf that sacrificed the facial artery and vein for intraoral reconstruction. Latysm anatomical considerations surface markings adjacent muscles vascular pattern motor nerve. During this procedure, the retracted scar is released from the trachea, left. The objective of this paper is to show that platysma flaps have good results and should be an alternative in reconstructive surgery for oral tumors when microsurgery is not possible. In selected cases, the flap will extend to the oropharynx. Platysma myocutaneous flap for reconstruction of intraoral defects. The technique reduces extensive surgical handling and avoids the facial nerve. Platysma myocutaneous flap for intraoral reconstruction. Platysma myocutaneous flap pmf is a generally used technique for. Role of platysma muscle flap in depressed scars of neck.
Muscles of the face, head and neck flashcards quizlet. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Combined tongue flap and vy advancement flap for lower lip defects. The platysma myocutaneous flap, operative techniques in. Overlapping double platysma flaps for the correction of. If i perform this backcut into the edge of the platysma muscle it helps to flatten out the platysma muscle band towards the center of the neck, but if the patients platysma muscle is extremely strong, a new band may form away. Platysma medical definition merriamwebster medical. Surgical technique the split orbicularis myomucosal flap. Since the first report of a platysma transverse myocutaneous flap in 1977, few articles about this flap design have been added to the literature. Platysma myocutaneous flap pmf is a generally used technique for defect reconstruction after an oral cancer resection. The advantages of platysma flap include good color match, easy access to the donor site in the same operative field with minimum morbidity of donor site, ease. The skin incision is made through the subcutaneous tissues and platysma muscle. A pedicled platysma myocutaneous flap is dissected c and rotated superiorely in to.
The platysma flap was first used by gersuny 1887 for reconstruction of a throughandthrough cheek defect. Platysma myocutaneous flap for reconstruction of intraoral. The plane of elevation should include the sternocleidomastoid fascia, as. Platysma flap an island myocutaneous flap based on the platysma muscle is ideal for reconstructing the superficial lining defects of oral cavity disadvantages of platysma flap. Rakesh kumar sandhir, a402, sector 31, noida 201 303, india. Current concepts, techniques, and principles intechopen. Research open access vertical platysma myocutaneous flap that sacrifices the facial artery and vein zhenning li1,2, ruiwu li1,2, fayu liu1,2, qigen fang1,2, xu zhang1,2 and changfu sun1,2 abstract background. Is it possible platysmaplasty can be done without any incision under the chin. Soft tissue reconstruction of the foot using the distally. We include a simple model of the aircraftsdynamics, re. Fortunately, the robust vascular supply of the face allows.
Psp facelift beverly hills platysma smas plication santa. This flap receives its blood supply primarily from branches of the a. This article presents a useful method, called lateral overlapping plication of the platysma lopp. I second platysmaplasty done and i still have prominent banding, what can i do. Manual crosschecking of their references yielded 3 more articles for a total of 31. We propose here the use of a platysma myocutaneous flap for the reimplantation of a severed ear in two surgical steps. Without the help of the epicranius, zygomaticus, triangurlis, quadratus labii, buccinator and platysma, little red riding hood would have been little more than a. Y fashion, joining the remaining vermilion border and the upper end of the flap. Joining his nine published cases, the mean length, width and lengthtowidth ratio of the flaps were slightly larger than ours 14.
Free flaps, particularly the radial forearm flap, provide excellent options for intraoral reconstruction of surgical defects. Reconstructive surgery in oral cancers prabha yadav. The lopplateral overlapping plication of the platysma. The outline of the platysma flap is initially made as an ellipse with the inferior margin low in the neck above the clavicle. Our experience of using a vertical platysma myocutaneous flap in a group of patients who underwent reconstruction after t2staged oral cancer surgical resection associated with neck dissection is.
Vertical platysma myocutaneous flap that sacrifices the. Platysma flap for reconstruction in oral submucous fibrosis osmf fibrotomy dpne at the occlusal level from corner of mouth to retromolar region bilateral coronidectomy done mouth openig of. Anterior flap the peripheral branches of the facial nerve. Lateral plication of the platysma can substitute medial plication in all cases, no matter the severity of the case, with several advantages. A corset platysmaplasty is the procedure of reattaching the left and right platysma muscles. I judge how much fat to leave on the undersurface skin flapto camouflage the platysma and avoid the harsh sculpted look that occurs when too much fat is removeddirectly by sight. Pdf platysma myocutaneous flap its current role in. Platysma transverse myocutaneous flap brazilian journal of. Vector i is vertical in the cervical midline, for the treatment of platysma muscle bands. This pdf is available for free download from a site hosted by medknow publications. The lateral intercostal artery perforator licap flap for.
Flap design in facial reconstruction is particularly delicate given the face is the most visible structure of the body and has some of the most complex threedimensional topography. Platysma myocutaneous flap is easy to harvest, thin and pliable, promoting threedimensional reconstruction, and there is a limited donor site morbidity with primary closure of the neck. I second platysmaplasty done and i still have prominent. It arises from the fascia covering the superior parts of the pectoralis major and the deltoideus. Sophus august vilhelm stein of copenhagen, denmark, described bilateral upper cen. Slaughter fitzhugh, md, charlottesville, virginia successful performance of the various types of ab lative and reconstructive head and. Facial rejuvenation is described through merging two key important points. A periodontal flap is a section of gingiva andor mucosa surgically separated from the underlying tissues to provide visibility and access to the bone and root surface. Platysma myocutaneous flap its current role in reconstructive surgery of oral soft tissue defects. Role of platysma muscle flap in depressed scars of neck rakesh k.
Platysma myocutaneous flap for intraoral reconstruction, am. Excess skin was then removed by suturing the flaps on both sides to the. The operation removes the excess platysma and tightens the muscle much like a corset. In an older patient the neck and face merge, so the sculpted architecture is lost.
William futrell, md, charlottesville, virginia michael e. Five cases are presented, three men and two women, 51 and 71. Superiorly based platysma myocutaneous flap was raised as described by gupta4 and used for. The first recorded crosslip flap was performed by pietro sabattini of innola, italy. In 1951, edgerton described a lateral cervical island flap based on the platysma muscle for reconstruction of intraoral defects. The diverse indications described for the platysma myocutaneous. Platysmaplasty a surgical resolution for the turkey neck. Pdf platysma myocutaneous flap its current role in reconstructive. Traditional facelifts do just what their name states. Angiographic study of the platysma, abstract background. A distally based sural flap was used for 10 cases for the hindfoot reconstruction, and. Vaginal reconstruction washingtonian plastic surgery. Originating from the pectoralis major muscle fascia, the platysma is a layer of muscle that has multiple insertions.
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