Smart flap of sternocleidomastoid muscle in anterior cervical spine surgery: Surgical anatomical dissection technique

Abstract

The use of sternocleidomastoid muscle flap has firstly been described in 1909. In spine surgery, it is usually reserved in the cases of revision after anterior cervical spine procedures. The aim of this article is to introduce its usage as prophylactic measure in cases at high risk of iatrogenic fistula formation. The procedure consists of three main steps: sternocleidomastoid isolation, flap design and harvesting, and flap fixation. The use of a surgical anchor allows a better adherence to the plate preventing hematoma formation. The use of SCM smart flap in primary anterior cervical spine surgery as a prophylactic method could be considered a safe and feasible procedure in patients with a high risk of iatrogenic fistulas. K E Y W O R D S cervical spine surgery, oesophageal fistula, oesophageal perforation, pedicled flap, sternocleidomastoid muscle flap

The Role of Smart-Flap of Sternocleidomastoid Muscle in Cervical Spine Surgery: A Proposal of a New Surgical Technique

“…The surgical technique was conceived as less invasive as possible in order to decrease the morbidity of the donor site and to prevent aesthetic damage as well as the so called "bulky" fl ap [25].…”

The role of “smart-flap” of sternocleidomastoid muscle in cervical spine surgery: A proposal of a new surgical technique

“…The surgical technique [25] was conceived as less invasive as possible in order to decrease the morbidity of the donor site and to prevent aesthetic damage as well as the so called "bulky" flap. The procedure is designed to be performed with an enlarged antero-medial incision following the anterior border of the SCM muscle and by platysma muscle split along the line of its fibers.…”

Oesophageal perforation following cervical spinal surgery with instrumentation: A case report on primary repair with pedicled sternocleidomastoid muscle flap reinforcement and review of the literature

“…The sternal end of the flap is detached from its insertion and there are two possible ways to transpose the flap. Either to rotate the flap at 180° or to transpose it medially 22 . Once the flap has been harvested and transposed, it should be anchored without tension, to ensure adequate blood supply.…”

“…Either to rotate the flap at 180 or to transpose it medially. 22 Once the flap has been harvested and transposed, it should be anchored without tension, to ensure adequate blood supply. Pedicled pectoralis major flap.…”