H incision—method of choice for radical neck dissection

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Abstract
To prevent skin necrosis, fistula formation and rupture of the carotid arteries after RND [radical neck dissection], vascularization of the skin of the neck was considered. The neck vessels (in cadavers) were injected with colored media and specimens of the skin were cleared (Spalteholz method). The arteries supplying the skin of the neck followed an obviously longitudinal course: 1 group of cutaneous arteries descending from the branches of the external carotid; another group ascending from the branches of the subclavian artery. The upper and lower groups of arteries joined approximately in the middle of the neck. The density of cutaneous arteries in the neck was poorer than in the facial skin. On the basis of these anatomic data, an incision for RND was proposed in the form of an H on 3/4 H, in which the transverse line of the incision follows the least vascularized skin region of the neck, without interrupting the great skin vessels. Incisions in the form of a Z or a double Y, or McFee''s incision, do not fulfil this requirement. The results of wound healing after RND in 184 patients who were operated from 1968-1975, where the H incision or 1 of its modifications was used in treating ear, nose and throat cancer.

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