Comparison between hockey stick and reversed hockey stick incision: gently curved single linear neck incisions for oral cancer.

Hockey stick incision (HSI) and reversed-HSI are known to be useful incisions for lymph node dissections of the neck. Both are gently curved single linear incisions without three-point suture line junctions, but are different at the base of the skin flap. The HSI allows the elevation of a superiorly-based single cervical skin flap and the reversed-HSI allows for an inferiorly-based flap. We compared the viability of the skin flaps, exposure of the operation field and cosmetic results to evaluate the characteristics of each incision. HSI appeared to be the suitable incision for radical neck dissection due to adequate exposure of the operation field while rendering excellent cosmetic results. Reversed-HSI was applied in combination with block resection of parts of the oral cavity because it provided much better exposure of the operation field than HSI, while still achieving acceptable cosmetic results. Using this technique, a small area of marginal necrosis was occasionally seen at the apex of the skin flap due to poor blood supply.