The modified apron (Akil) incision: a technical modification to prevent subcutaneous emphysema in partial vertical and supracricoid laryngectomy.

OBJECTIVE

To describe a modified apron (Akil) incision technique designed to prevent postoperative subcutaneous emphysema in patients undergoing open partial laryngectomy by maintaining an anatomical barrier between the laryngectomy field and the tracheostomy site.

METHODS

This study presents a technical modification applied in patients undergoing open partial laryngectomy, including supracricoid partial laryngectomy and partial verticallaryngectomy. The incision begins bilaterally at the mastoid tips, extends inferiorly along the anterior border of the sternocleidomastoid muscle, and terminatesapproximately 2 cm above the sternal notch. Unlike the conventional apron incision, an intact full-thickness skin bridge (approximately 2-2.5 cm in height) is preservedwithout undermining. All laryngeal framework procedures are performed superior to this bridge, while the tracheostomy is created inferiorly, preventing directcommunication between the two surgical fields.

RESULTS

A total of 23 patients were included. None developed clinically significant subcutaneous emphysema requiring intervention. Minor complications included one wound infection, one seroma managed with drainage and compression, and one case of partial wound dehiscence requiring revision. No complications were directly attributable to the incision design.

CONCLUSION

The modified Akil incision provides a simple and effective anatomical barrier that may reduce the risk of postoperative subcutaneous emphysema following open partial laryngectomy. This technique is easily reproducible and may improve postoperative outcomes without increasing complication rates.