Systematic review of the platysma myocutaneous flap for head and neck reconstruction

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 chi(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.