Sternocleidomastoid flap for pedicled reconstruction in head & neck surgery- revisiting the anatomy and technique

World Journal of Surgical Oncology

Shashi Kant Pandey¹  Ram Chandra Shukla²  Esha Pai³  Manoj Pandey⁴  Tarun Kumar⁴  Apurva Srivastava⁵ 

[1] Department of Anatomy, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India;Department of Radiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India;Department of Surgical Oncology, Heritage Hospital, Varanasi, India;Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India;Department of Vascular Surgery, Sir Gangaram Hospital, New Delhi, India;

关键词: Sternocleidomastoid;    flap;    Head and Neck Cancer;    Reconstruction;    Cadaver;    Angiography;    Superior Thyroid Artery;   

DOI  :  10.1186/s12957-021-02470-5

来源: Springer

【 摘 要 】

BackgroundPrevious studies on sternocleidomastoid flaps, have defined the importance of preserving sternocleidomastoid (SCM) branch of superior thyroid artery (STA). This theory drew criticism, as this muscle is known to be a type II muscle, i.e., the muscle has one dominant pedicle (branches from the occipital artery at the superior pole) and smaller vascular pedicles entering the belly of muscle (branches from STA and thyrocervical trunk) at the middle and lower pole respectively. It was unlikely for the SCM branch of STA to supply the upper and lower thirds of the muscle. We undertook a cadaveric angiographic study to investigate distribution of STA supply to SCM muscle.MethodsIt is a cross-sectional descriptive study on 10 cadaveric SCM muscles along with ipsilateral STA which were evaluated with angiography using diatrizoate (urograffin) dye. Radiographic films were interpreted looking at the opacification of the muscle. Results were analyzed using frequency distribution and percentage.ResultsOut of ten specimens, near complete opacification was observed in eight SCM muscle specimens. While one showed poor uptake in the lower third of the muscle, the other showed poor uptake in the upper third segment of muscle.ConclusionBased on the above findings we suggest to further investigate sternocleidomastoid muscle as a type III flap, as the STA branch also supplies the whole muscle along with previously described pedicle from occipital artery. However, this needs to be further corroborated intra-operatively using scanning laser doppler. This also explains better survival rates of superior thyroid artery based sternomastoid flaps.

【 授权许可】

CC BY