Introduction and background

In 1986, Wang first described the infrahyoid myocutaneous flap (IHF) for reconstruction in the head and neck region [1]. The IHF is versatile and relatively easy to perform, and many surgeons consider it an alternative to free flaps for medium-sized defects. The advantages of the IHF include good color match, access to the donor site within the same operative field, minimal donor-site morbidity, primary donor-site closure, and appropriate flap thickness for oral defects.

However, the traditional IHF technique has several disadvantages and limitations. Reconstructions using the IHF have frequently encountered problems related to skin-paddle reliability. The IHF is thin and pliable, with a typical skin island averaging 7 × 4 cm. Therefore, the IHF is not suitable for extensive defects that require larger, bulkier flaps. In the traditional technique, the skin paddle is limited to a vertical orientation below the hyoid bone. The IHF also has a relatively short pedicle compared with microvascular free flaps [1-3].

To improve the reliability and versatility of the IHF, modifications to the traditional technique may be beneficial, and several authors have reported favorable outcomes with modified techniques. However, conclusions regarding the optimal surgical technique remain inconclusive because most studies are retrospective and have small sample sizes.

This review aimed to examine and summarize the existing literature on definitions and classifications of modifications for IHF reconstruction. The surgical techniques and flap viability associated with each technique were reviewed.