Ten Commandments of Safe and Optimum Neck Dissection

Sir,

We read with keen interest the article by Chintamani et al. regarding Ten Commandments of Safe and Optimum Neck dissection [1]. We would like to take this opportunity to commend the author for not just simplifying the difficult steps but for also describing the intricate details and practical aspects of this delicate and major surgery in a comprehensive way.

The author has laid emphasis at various places on the importance of being well versed with surgical anatomy of the neck. It is like GPS (Global Positioning System). If one has the GPS, one does not only reach the destination but also reaches faster and safer with minimal complications or damage to other structures.

The author has described Modified Schobinger’s incision in terms of surface marking and has also explained the relevance of the modification. This lazy ‘S’ incision [1] provides very good cosmetic outcome by minimising the chances of scar contracture. The various scenarios where different incisions would be more useful have also been mentioned. However, it would have been helpful if the landmarks for extent of raising the anterior and posterior flaps were also described.

We would also like to mention here that sternocleidomastoid muscle should be cut instead of retracting it because there are lymph nodes adhered to the undersurface of the muscle which might get left behind. It would be enlightening if the author could also mention about the usefulness of putting any suction drain after neck dissection.

To conclude, this is a masterly effort to demonstrate steps of neck dissection which can be clearly imagined upon reading the article and it just cannot be described any better considering that the article discusses all the aspects including surgical anatomy, step-wise dissection, ways to prevent any injury to vital structures and classification related to neck dissection.

To learn about a lighthouse (navigational aid) at almost every step of this inherently complicated surgery makes it appear possible for the surgical residents to do it properly. The title is justified as precise surgical instructions specific to neck dissection have been provided in the form of commandments that can be followed blindly to perform this surgery optimally and safely.

Reference

  1. 1.

    Chintamani (April 2015) Editorial (2015 Apr) Ten commandments of safe and optimum neck dissections for cancer. Indian J Surg 77(2):85–91. https://doi.org/10.1007/s12262-015-1277-9

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Correspondence to Sukriti Rastogi.

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Rastogi, S. Ten Commandments of Safe and Optimum Neck Dissection. Indian J Surg 81, 610 (2019). https://doi.org/10.1007/s12262-019-01863-x

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