The Sternocleidomastoid Flap—Its Indications and Limitations

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Abstract
The sternocleidomastoid (SCM) flap seems to be a practicable but underestimated flap for reconstructive and plastic surgery of the head and neck. To determine in which situations the SCM flap may represent a reliable alternative to other flaps used in head and neck surgery. Meta-analysis of the complete literature on the SCM flap. All literature found dealing with the SCM flap was reviewed, with special emphasis placed on the indications and success rates reported. The data presented are compared with our own morphologic findings and their putative clinical implications. Four types of SCM flap have been described: the muscle flap, the myocutaneous flap, the myoperiosteal flap, and the myosseus or osteomuscular flap. The SCM flap was either superiorly or inferiorly based. The SCM muscle flap was used in a total of 72 patients with only 1 major complication and 7 minor complications. The complication rate, therefore, is 11%. The applications of the muscle flap involved prevention of Frey's syndrome, closure of orocutaneous fistulae and soft tissue deficiencies, closure of pharyngocutaneous and cervical esophageal fistulae, and reconstruction of the tongue. Furthermore, Conley reported on the use of the SCM muscle flap in a group of 30 patients to reanimate the face, reconstruct oral cavity defects, protect the carotid and innominate artery, and even to aid shoulder elevation after poliomyelitis. The SCM myocutaneous flap seems to be the most common application, with a total of 138 patients. All in all, a total of 29 complications (21%) was reported, with partial skin necrosis by far the most frequent. Total failure of the flap has been described in 10 patients (7%). The SCM myocutaneous flap was used for closure of defects of the mouth as well as oro-, pharyngo-, and tracheocutaneous fistulae, facial reconstruction, reconstruction of mastoid defects, and reconstruction of the laryngotracheal complex in children. The SCM myosseus or osteomuscular flap was reported in 23 patients. Flap necrosis is reported in 1 case (4%). The SCM osteomuscular flap was used to reconstruct defects of the lower jaw in all patients. The SCM myoperiosteal flap was used in a total of 49 patients. The complication rate reported is 6% (3 cases). The myoperiosteal flap was used for reconstruction of the laryngotracheal complex in adults and for esophagopharyngeal reconstruction and fistula repair. The data presented in previous literature is well correlated with our own morphologic findings. In comparison of the different techniques applied with the assumptions drawn on the basis of our own anatomic findings, it becomes evident that the SCM flap is only a useful tool in limited indications and under certain precautions.