Assessment of the Outcomes of a Modified Version of the Reverse Hockey Stick Incision (mRHSI): A single Institutional Ambispective Longitudinal Study

Abstract

Background: Neck dissection is a cornerstone of head and neck cancer management, requiring an incision design that balances surgical exposure with skin viability and cosmesis. Traditional designs, such as the Y-shaped incision, often suffer from poor blood supply at trifurcation points, leading to vessel exposure and wound breakdown. Objectives: This study aimed to assess the outcomes of a modified version of the Reverse Hockey Stick Incision (mRHSI). The primary objective was to evaluate its usability and feasibility in a large clinical sample, focusing on intraoperative accessibility and postoperative complications. Methods: An ambispective longitudinal study was conducted from May 2018 to March 2022, involving 451 patients with oral, oropharyngeal, or parotid malignancies. The mRHSI utilizes a gentle curve 3–4 cm below the angle of the mandible along the skin crease, extending longitudinally toward the mid-clavicle. Parameters assessed included dissection duration, marginal necrosis, wound dehiscence, and long-term cosmesis using the Vancouver Scar Scale (VSS). Results: The mean dissection time was 22.49 +/- 1.69 minutes, significantly shorter than historical rates for MacFee or Schobinger incisions (p < 0.001). Complication rates remained low, with marginal necrosis at 3.1% and wound dehiscence requiring re-suturing at 2.4%. Scar assessment showed significant longitudinal improvement, with mean VSS scores decreasing from 11.43 at discharge to 2.81 at the three-year follow-up (p < 0.001). Approximately 85.6% of patients reported "good" or "satisfactory" cosmetic feedback. Conclusion: The mRHSI provides excellent surgical exposure and accessibility while minimizing operative time and flap-related complications. By avoiding acute angles and three-point junctions, the modification ensures superior healing and favorable cosmetic outcomes without compromising oncological radicality.