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Use of a sternocleidomastoid muscle flap to protect the carotid artery during laryngectomy

Published online by Cambridge University Press:  12 May 2021

J C Fleming*
Affiliation:
Liverpool Head and Neck Centre and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
A R Fuson
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Louisiana State University Health Sciences Center – New Orleans, New Orleans, USA
H Jeyarajan
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, USA
C M Thomas
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, USA
B Greene
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, USA
*
Author for correspondence: Mr Jason C Fleming, Liverpool Head and Neck Centre, Aintree University Hospital, Lower Lane, LiverpoolL9 7AL, UK E-mail: [email protected]

Abstract

Objectives

This paper describes a simple method of securing tissue coverage of the great vessels at the initial surgery by rotating the divided sternal heads of the sternocleidomastoid muscle, a routine step during laryngectomy, and approximating them to the prevertebral fascia. The paper presents an illustrated case example where this technique in a salvage laryngectomy repair resulted in a protected vascular axis following a salivary leak.

Results

Since utilising this technique, there has been a marked reduction in the requirement of subsequent flap procedures to protect vessels, and no episodes of threatened or actual carotid blowout.

Type
Short Communications
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Mr J C Fleming takes responsibility for the integrity of the content of the paper

References

Pathak, KA, Viallet, NR, Nason, RW. Sternocleidomastoid muscle interposition to prevent carotid artery blowout. J Surg Oncol 2008;98:565–6CrossRefGoogle ScholarPubMed
Liang, NL, Guedes, BD, Duvvuri, U, Singh, MJ, Chaer, RA, Makaroun, MS et al. Outcomes of interventions for carotid blowout syndrome in patients with head and neck cancer. J Vasc Surg 2016;63:1525–30CrossRefGoogle ScholarPubMed
Leclère, FM, Vacher, C, Benchaa, T. Blood supply to the human sternocleidomastoid muscle and its clinical implications for mandible reconstruction. Laryngoscope 2012;122:2402–6CrossRefGoogle Scholar
Wei, D, Liu, JH, Zhao, WQ, Zhu, HY, Li, ZY, Wang, HM. Use of the versatile sternocleidomastoid flap in oral and maxillofacial surgery: our experience. Br J Oral Maxillofac Surg 2013;51:742–6CrossRefGoogle ScholarPubMed
Conley, J, Gullane, PJ. The sternocleidomastoid muscle flap. Head Neck Surg 1980;2:308–11CrossRefGoogle ScholarPubMed
González-García, R, Moreno-García, C, Moreno-Sánchez, M, Román-Romero, L. Straightforward method for coverage of major vessels after modified radical neck dissection. J Oral Maxillofac Surg 2017;75:1299.e11299.e4CrossRefGoogle ScholarPubMed
Mclean, JN, Nicholas, C, Duggal, P, Chen, A, Grist, WG, Losken, A et al. Surgical management of pharyngocutaneous fistula after total laryngectomy. Ann Plast Surg 2012;68:442–5CrossRefGoogle ScholarPubMed
Schneider, DS, Wu, V, Wax, MK. Indications for pedicled pectoralis major flap in a free tissue transfer practice. Head Neck 2012;34:1106–10CrossRefGoogle Scholar
Liu, R, Gullane, P, Brown, D, Irish, J. Pectoralis major myocutaneous pedicled flap in head and neck reconstruction: retrospective review of indications and results in 244 consecutive cases at the Toronto General Hospital. J Otolaryngol 2001;30:3440CrossRefGoogle Scholar