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The sternocleidomastoid myoperiosteal flap for esophagopharyngeal reconstruction and fistula repair: Clinical and experimental study
Author(s) -
Friedman Michael,
Toriumi Dean M.,
Chilis Thomas,
Strorigl Terri,
Skolnik Emanuel
Publication year - 1988
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1288/00005537-198810000-00011
Subject(s) - medicine , sternocleidomastoid muscle , fistula , surgery
Despite advances in head and neck surgery, reconstruction of the pharynx and cervical esophagus continues to be troublesome. Classic pedicled flaps are often too bulky and difficult to position for repair of pharyngeal and esophageal fistulas. An ideal flap would be local, well‐vascularized, compact, and capable of being sutured into a tension‐free, watertight seal. In selected cases, the sternocleidomastoid myoperiosteal flap can meet these requirements in a single‐stage procedure for repair of fistulas as well as selected cases of primary pharyngeal reconstruction. The use of this flap is described in five patients. Two patients underwent laryngectomy with partial pharyngectomy that left inadequate mucosa for primary closure. A sternocleidomastoid myoperiosteal flap was used to add width to the remaining mucosa. Both patients healed within 3 weeks and remained stricture free. Three other patients who underwent radiation followed by tumor resection and standard primary closure of the pharynx developed fistulas. Two fistulas were repaired successfully with the sternocleidomastoid myoperiosteal flap, and both patients were able to eat a general diet on the eighth postoperative day. Reconstruction was also performed in dogs to histologically evaluate the epithelialization capacity of the periosteum. There was total epithelialization of the flap at 4 weeks after reconstruction.