Composite platysmofascial flap in reconstruction following partial vertical laryngeal resections

Objectives: The superficial layer of deep cervical fascia represents a valuable material for the reconstruction of defects secondary to partial vertical laryngeal resections. However, there are drawbacks to the use of this flap, which include possible weakness and subsequent instability of the laryngeal wall. Methods: To overcome this problem, we included platysma along with the superficial layer of deep cervical fascia to form a composite soft tissue flap that will meet all reconstructive needs following partial vertical laryngeal resection. Results: Inclusion of platysma yields more durable and adequately vascularized flap resistant to saliva, seroma formation, and infection. Because of segmental blood supply of strap muscles and their indirect perforating vessels, medially based horizontal composite flap is better supplied with blood in comparison with cranially based vertical flap. Medial insertion of the horizontal flap is much more convenient than lateral, due to ancillary blood supply from the contralateral side and easier pursuance of ipsilateral neck dissection. Conclusions: The method of our choice for laryngeal reconstruction after partial vertical laryngeal resections is paramedially based horizontal platysmofascial composite flap with the insertion opposite to the side of the primary laryngeal tumor.