U-shaped strap muscle flap for difficult thyroid surgery

How-Yun Ko; I-Cheng Lu; Pi-Ying Chang; Ling-Feng Wang; Che-Wei Wu; Wing-Hei Viola Yu; Tzer Zen Hwang; Chien Chung Wang; Tzu-Yen Huang; Feng-Yu Chiang

doi:10.21037/gs.2020.02.20

U-shaped strap muscle flap for difficult thyroid surgery

Gland Surg. 2020 Apr;9(2):372-379. doi: 10.21037/gs.2020.02.20.

Authors

How-Yun Ko¹, I-Cheng Lu^{2

3}, Pi-Ying Chang³, Ling-Feng Wang^{1

2}, Che-Wei Wu^{1

2}, Wing-Hei Viola Yu¹, Tzer Zen Hwang^{4

5}, Chien Chung Wang⁵, Tzu-Yen Huang^{1

6}, Feng-Yu Chiang^{4

5}

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
² Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
³ Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁴ School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
⁵ Department of Otolaryngology, E-Da Hospital, Kaohsiung, Taiwan.
⁶ Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.

Abstract

Background: Open thyroidectomy via conventional midline approach can be challenging in complex thyroid surgeries. This study proposes a U-shaped strap muscle flap (USMF) technique that provides adequately wide exposure of the surgical field.

Methods: Strap muscles were cut close to the clavicle and along the anterior margin of both sternocleidomastoid muscles followed by total thyroidectomy in 20 patients as USMF group, and surgical outcomes were compared with 40 patients who had received total thyroidectomy via midline approach.

Results: No patient had postoperative hematoma, vocal cord paralysis, permanent hypocalcaemia, wound infection or flap necrosis. At 2 months post-surgery, objective voice analysis and subjective assessment of voice and swallowing showed no significant difference between groups.

Conclusions: USMF provides superb surgical field exposure, and the voice and swallowing functions after USMF are comparable to those obtained by midline approach. The USMF approach is a feasible option for selective difficult thyroid surgery.

Keywords: U-shaped strap muscle flap (USMF); swallowing; thyroid; thyroidectomy; voice.