Biologic Basis of De-Epithelialized Transverse Platysma Flap for Oral Cavity Reconstruction

Document Type : Original


1 Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.


The inferiorly and laterally based platysma myocutaneous flap contains hair in some ethnics; therefore, it is required to change the myocutaneous flap to myofascial flap to prevent the hair growth after its transfer to the oral cavity.
Materials and Methods:
Five male mongrel dogs were selected for this study. De-epithelialized laterally based platysma flap, muscle part facing the oral cavity, was used for buccal reconstruction. The clinical healing process was photographed every week. After 40 days, biopsy specimens were obtained from the transferred flap.
According to the results, all flaps survived. At the end of the first week, the flap was covered with fibrinous exudate. On the third week, only the center of the transferred flap was not covered with mucosa. Within 40 days, the flap was distinguishable clinically from the adjacent buccal mucosa just by hypopigmentation. Hematoxylin and eosin staining of the biopsy specimens taken on day 40 showed thin stratified squamous epithelium covered with a tiny parakeratin layer.
Myofascial platysma flap, muscle part faced oral cavity, survives and undergoes mucosalization after adaptation to the recipient oral tissue.


Main Subjects

1. Wada T, Nakatani K, Hiraishi Y, Negoro K, Iwagami Y, Fujita S. Usefulness of myofascial flap without skin in contemporary oral and maxillofacial reconstruction. J Oral Maxillofac Surg 2011; 69(6): 1815-25.
2. Tessier P, Matthews DC, Kamerer D Jr, Ciminello FS, Gargano F, Wolfe SA.Platysma-based myocutaneous clavicular island flap for intraoral reconstruction. Ann Plast Surg 2011;67(6):S55-69.
3. Jackel MC. Platysma myofascial flap for reconstruction of oropharyngeal defects after transoral laser microsurgery of locally advanced carcinomas. J Laryngol Otol 2006;120(12):1055-8.
4. Chang SY. Reconstruction of circumferential defect of the hypopharynx: experimental studies and clinical application of a new method. Laryngoscope 1989; 99(7 Pt 1):736-40.
5. Dursun G, Ozgursoy OB. Laryngeal reconstruction by platysma myofascial flap after vertical partial laryngectomy. Head Neck 2005; 27(9):762-70.
6. Lin YD, Jiang YG, Wang RW, Gong TQ, Zhou JH. Platysma myocutaneous flap for patch stricturoplasty in relieving short and benign cervical esophageal stricture. Ann Thorac Surg 2006; 81(3):1090-4.
7. Hayashi A, Mochizuki M, Suda S, Natori Y, Ando E, Yoshizawa H, et al. Effectiveness of platysma muscle flap in preventing Frey syndrome and depressive deformities after parotidectomy. J Plast Reconstr Aesthet Surg 2016;69(5):663-72.
8. Rahpeyma A, Khajehahmadi S. Submental artery island flap in intraoral reconstruction: a review. J Craniomaxillofac Surg 2014;42(6):983-9.
9. Hall RR, Pearce DJ, Brown T, McMichael AJ. Unwanted palatal hair: a consequence of complex oropharyngeal reconstruction. J Dermatolog Treat 2009; 20(3):149-51.
10. Rahpeyma A, Khajehahmadi S. Oral reconstruction with submental flap. Ann Maxillofac Surg 2013;3(2):144-7.
11. Elshal EE, Inokuchi T, Sekine J, Sano K.Experimental study of epithelialization of the muscle-only flap in the oral cavity. J Oral Maxillofac Surg 1997;55(12):1423-30;discussion 31-2.
12. Syme DB, Shayan R, Grinsell D. Muscle-only intra-oral mucosal defect reconstruction. J Plast Reconstr Aesthet Surg 2012;65(12):1654-9.
13. Johnson MA, Langdon JD. Is skin necessary for intraoral reconstruction with myocutaneous flaps? Br J Oral Maxillofac Surg 1990;28(5):299-301.
14. Kawashima T, Harii K, Ono I, Ebihara S, Yoshizumi T. Intraoral and oropharyngeal reconstruction using a de-epithelialized forearm flap. Head Neck 1989; 11(4):358-63.
15. Ariyan S. One-stage reconstruction for defects of the mouth using a sternomastoid myocutaneous flap. Plast Reconstr Surg 1979;63(5): 618-25.
16. Ao M, Uno K, Maeta M, Nakagawa F, Saito R, Nagase Y.De-epithelialised anterior (anterolateral and anteromedial) thigh flaps for dead space filling and contour correction in head and neck reconstruction. Br J Plast Surg 1999;52(4):261-7.
17. Phillips JG, Postlethwaite K, Peckitt N. The pectoralis major muscle flap without skin in intra-oral reconstruction. Br J Oral Maxillofac Surg 1988;26(6):479-85.
18. Cheung LK. The epithelialization process in the healing temporalis myofascial flap in oral reconstruction. Int J Oral Maxillofac Surg 1997;26(4):303-9.
19. Eliachar I, Kraus DH, Bergfeld WF, Tucker HM.Prevention of hair growth in myocutaneous flap reconstruction. Arch Otolaryngol Head Neck Surg 1990;116(8):923-7.
20. Dundas JM, Fowler JD, Shmon CL, Clapson JB.Modification of the superficial cervical axial pattern skin flap for oral reconstruction. Vet Surg 2005;34(3):206-13.
21. Wong TY, Chung CH, Huang JS, Chen HA. The inverted temporalis muscle flap for intraoral reconstruction: its rationale and the results of its application. J Oral Maxillofac Surg 2004;62(6):
22. Imanishi N, Nakajima H, Kishi K, Chang H, Aiso S. Is the platysma flap musculocutaneous? Angiographic study of the platysma. Plast Reconstr Surg 2005;115(4):1018-24.
23. Grahn JC, Reilly DA, Nuccitelli RL, Isseroff RR. Melanocytes do not migrate directionally in physiological DC electric fields. Wound Repair Regen 2003;11(1):64-70.