The Sternocleidomastoid Flap for Oral Cavity Reconstruction: Extended Indications and Technical Modifications

Sternocleidomastoid Flap for Oral Cavity Reconstruction: Extended Indications and Technical Modifications

Chun-Feng Chen ^a,b  DDS, MS, Associate Professor  
陳竣峰 主任

a Department of Oromaxillofacial Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

 b Dental Laboratory Technology, Shu Zen College of Medicine & Management, Kaohsiung, Taiwan

Abstract

Purpose: Several investigators have found that preserving the superior thyroid artery flap can considerably increase the survival rate of the sternocleidomastoid (SCM) flap. Nevertheless, they have recommended not cleaning the lymph nodes above level II for occipital artery preservation, which can leave risky metastatic lymph nodes and restrict the application of the SCM flap in patients with at least stage N1. The authors propose that preserving only the superior thyroid arteriovenous system is sufficient to ensure survival of the SCM flap and preserving the occipital artery is not necessary. They also propose preserving the cranial portion of the external jugular vein for improved venous return of the skin paddle.

Patients and Methods: This study retrospectively examined 20 patients with oral cancer (18 male, 2 female; 33 to 92 yr old; median age, 57.5 yr) who underwent SCM flap reconstruction from September 2011 to September 2014. All patients underwent surgical resection and immediate reconstruction with the SCM flap.

Results: The dimensions of the skin paddle ranged from 5x4 to 8x5 cm (length x width; mean, 6.7x4.2 cm). Arteriovenous type 1A1V of the superior thyroid arteriovenous system accounted for 30% of cases, 1A2Vaccounted for 30% of cases, 2A2Vaccounted for 25% of cases, 2A1Vaccounted for 5% of cases, 2A3V accounted for 5% of cases, and 3A2V accounted for 5% of cases. The mean number was 10.7 lymph nodes (standard deviation, 4.1 lymph nodes) per dissection above level II and 2 cases had level II lymph nodes metastasis. Only 1 case (5%) exhibited marginal loss of the skin paddle. The average operative time was 6.8 ±0.9 hours and hospitalization was 12 ± 2.2 days. Follow-up ranged from 2 to 36 months. Two patients died of metastatic disease and 2 patients developed neck recurrences.

Conclusions: Using the SCM flap with modifications is a reliable and convenient technique with wide application in the reconstruction of head and neck defects.