Including the platysma muscle in a cervicofacial skin rotation flap to enhance blood supply for reconstruction of vast orbital and cheek defects: Anatomical considerations and surgical technique

The surgical technique introduced in this work describes a modification of the rotation skin flap that includes the platysma muscle in order to improve the blood supply of the flap. This modified rotation flap enables sufficient reconstruction of extended regions following ablative surgery of the head and neck. The anatomy and clinical application of a bilayer cervicofacial skin-platysma rotation flap is described in 6 patients. Flap design ensures sufficient blood perfusion mainly via the occipital artery, the superficial cervical artery and the transverse cervical artery; venous drainage is achieved by the external jugular vein and by randomised vascularisation. The surgical procedures led to sufficient and successful reconstruction of the orbital and cheek region. Further oncological management, such as neck dissection and total parotidectomy could be performed through the flap approach because of the adequate exposure of neck structures. Due to the sensory supply reaching the flap dorsally, sensibility in the reconstructed region could be regained in all patients. This modified skin-platysma rotation flap represents an appropriate surgical technique for safe and simple closure of vast orbital and cheek defects with enhanced blood supply, which enables the extended mobilization required after ablative surgery of the orofacial region.