According to a systematic review published across database records from 1986 to 2025, modified infrahyoid myocutaneous flap techniques have reduced overall reconstructive failure rates to between 0% and 20%, marking a sharp departure from the 10% to 47% failure rates historically associated with Wang’s traditional 1986 technique. Surgeons evaluating head and neck cancer reconstruction options now face a growing body of literature detailing how specific anatomical adjustments—ranging from periosteal strap muscle release to superficial vein preservation—resolve the reliability issues that once limited the flap’s use for medium-sized oral defects.
Evolution of Flap Modifications and Venous Drainage Improvements
Venous congestion remains a hurdle in traditional infrahyoid flap procedures because standard harvests sacrifice superficial venous pathways. According to a systematic review evaluating 22 studies from 1986 to 2025, Dolivet introduced a modification in 2005 featuring periosteal release of the strap muscles from the hyoid bone. Across the studies implementing Dolivet’s approach, the failure rate of this modification was 1.1%.
Pro Tip: When performing complex head and neck reconstructions following tumor resection, the preservation of superficial venous drainage, including the anterior jugular vein, was noted by Ouyang and Peng in comparative cohort studies as a method to improve flap reliability.
Further refining venous reliability, Deganello et al. preserved a connection between the superficial and median cervical fasciae around the pedicle in 2007. Additional studies by Peng et al. in 2013 demonstrated that preserving the anterior jugular vein dropped overall flap loss significantly compared to non-preservation groups, with comparative p-values falling below 0.01.
Comparative Outcomes of Traditional Versus Modified Infrahyoid Flaps
Comparative cohort studies highlight the clinical advantage of surgical modifications over the baseline technique established by Wang. In a 2005 cohort study by Dolivet et al., the traditional technique yielded an 11.5% overall flap loss rate across 61 cases, whereas the modified approach reduced failures to 1.1% across 91 cases, establishing a statistically significant difference with a p-value below 0.01. Similarly, Peng et al. reported that non-preservation of superficial veins resulted in a 57.1% flap loss rate, which fell to 0% when the anterior jugular vein was intentionally preserved.
| Study & Year | Traditional / Control Loss | Modified Technique Loss | P-Value |
|---|---|---|---|
| Dolivet et al. (2005) | 11.5% (7/61) | 1.1% (1/91) | <0.01 |
| Peng et al. (2013) | 57.1% (4/7) | 0% (0/13) | <0.01 |
| Chotipanich (2025) | 32.4% (11/34) | 15.4% (4/26) | 0.23 |
Despite these favorable metrics, surgeons must navigate distinct anatomical limitations. The traditional vertical skin paddle averaging 7 by 4 centimeters lacks the bulk required for extensive defects. To overcome dimensional restrictions, Ricard et al. introduced a horizontal flap design in 2009 for midline-crossing defects, while Yan et al. designed a modification in 2020 for reconstruction after vertical hemicricolaryngopharyngectomy. More recently, Li et al. demonstrated in 2021 that tailored infrahyoid flaps can successfully reconstruct pharyngotracheal voice tubes following total laryngectomy.
Frequently Asked Questions
What is the primary advantage of the modified infrahyoid myocutaneous flap?
Modified techniques improve venous drainage and flap reliability, lowering overall failure rates from a historical range of 10% to 47% down to between 0% and 20%, according to published systematic review data.
Why was Dolivet’s 2005 modification considered a turning point?
Dolivet introduced the periosteal release of strap muscles from the hyoid bone, which reduced flap loss to approximately 1.1% in initial cohort findings.
Are there oncologic risks to preserving superficial veins during flap harvest?
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