Raising The Flaps

The superficial layer of the cervical fascia must remain intact after the flaps have been raised. This may pose a problem to the novice surgeon, who usually finds it difficult to preserve the integrity of this fascial layer. The best way to achieve this goal is by cutting with the scalpel over the deep face of the platysma muscle. As for any other type of neck dissection, the platysma muscle is included with the skin flaps because it provides additional blood supply that protects the skin and assists in the healing process. The proper sequence for an adequate incision will be to mark the skin incision,

Figure 5-2 Fibrofatty tissue is best dissected with the scissors. Here an example of the dissection of the supraclavicular fossa on the right side. SC, sternocleidomastoid muscle retracted medially; sn, supraclavicular nerve.

Figure 5-3 Regularly washing the field allows better visualization of the anatomical structures. SG, submandibular gland; IJ, internal jugular vein; ca, carotid artery; lv, lingual veins; sa, spinal accessory nerve; hn, hypoglossal nerve; SC, sternocleidomastoid muscle; oh, omohyoid muscle; sh, sternohyoid muscle; sp, splenius capitis muscle; ls, levator scapulae muscle; ND, neck dissection specimen.

Figure 5-3 Regularly washing the field allows better visualization of the anatomical structures. SG, submandibular gland; IJ, internal jugular vein; ca, carotid artery; lv, lingual veins; sa, spinal accessory nerve; hn, hypoglossal nerve; SC, sternocleidomastoid muscle; oh, omohyoid muscle; sh, sternohyoid muscle; sp, splenius capitis muscle; ls, levator scapulae muscle; ND, neck dissection specimen.

Figure 5-4 Fibers of the platysma muscle after elevation of the skin flaps.

incise the skin, cut the platysma muscle, and start raising the flap, keeping the deep face of the platysma under vision. If the muscular fibers of the platysma are seen throughout the elevation of the skin flaps (Fig. 5-4), preservation of the superficial layer of the cervical fascia is assured.

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