Sternocleidomastoid Muscle Flap in Esophageal Perforation Repair After Cervical Spine Surgery

Benazzo, Marco; Spasiano, R.; Bertino, Giulia; Occhini, Antonio; Gatti, Patrizia

doi:10.1097/bsd.0b013e31815c5f96

Cited by 41 publications

(32 citation statements)

References 58 publications

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“…16 Sternocleidomastoid muscle flaps have also been used to successfully close cervical esophageal fistulas after anterior cervical spine surgery. 17,18 Other moderately aggressive interventions include the use of covered metal stents to occlude anastomotic leaks. 4,19 However, these methods do not negate the need for drainage and debridement of necrotic tissue if present.…”

Section: Figurementioning

confidence: 99%

Successful Management of Cervicoesophageal Anastomosis Leak After Microsurgical Esophageal Reconstruction

Dodd¹,

Goodnight²,

Pu³

2010

Annals of Plastic Surgery

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Free visceral and, more recently, free fasciocutaneous flaps are becoming increasingly common for esophageal reconstruction. However, complications of free flap conduit ischemia, specifically anastomotic leak have not been frequently discussed in the literature. This article provides a detailed description of total esophageal reconstruction with an 18 x 8.5 cm tube free radial forearm flap. A clinically significant cervical anastomosis leak was contained and healed with an innovative surgical rearrangement of local muscle flaps and closed suction drainage. We discuss the literature associated with cervical anastomotic leaks after visceral reconstruction and adapt those principles to the unique physiology of free fasciocutaneous flaps to develop a simple but reliable salvage option. This approach should be considered by reconstructive surgeons when helping other surgeons to manage an anastomotic leak after a cervical esophageal reconstruction in a similar setting.

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Section: Figurementioning

confidence: 99%

Successful Management of Cervicoesophageal Anastomosis Leak After Microsurgical Esophageal Reconstruction

Dodd¹,

Goodnight²,

Pu³

2010

Annals of Plastic Surgery

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“…However, the most preferable therapeutic strategy is immediate surgical repair (3,91,93,95,(101)(102)(103)(104)(105). The importance of intraoperative or early recognition of this complication cannot be overemphasized.…”

Section: Esophageal Perforationmentioning

confidence: 99%

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Τάσιου¹,

Giannis²,

Brotis³

et al. 2017

J. Spine Surg.

120

113

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Anterior cervical spine procedures have been associated with satisfactory outcomes. However, the occurrence of troublesome complications, although uncommon, needs to be taken into consideration.The purpose of our study was to assess the actual incidence of anterior cervical spine procedure-associated complications and identify any predisposing factors. A total of 114 patients undergoing anterior cervical procedures over a 6-year period were included in our retrospective, case-control study. The diagnosis was cervical radiculopathy, and/or myelopathy due to degenerative disc disease, cervical spondylosis, or traumatic cervical spine injury. All our participants underwent surgical treatment, and complications were recorded.The most commonly performed procedure (79%) was anterior cervical discectomy and fusion (ACDF).Fourteen patients (12.3%) underwent anterior cervical corpectomy and interbody fusion, seven (6.1%) ACDF with plating, two (1.7%) odontoid screw fixation, and one anterior removal of osteophytes for severe Forestier's disease. Mean follow-up time was 42.5 months (range, 6-78 months). The overall complication rate was 13.2%. Specifically, we encountered adjacent intervertebral disc degeneration in 2.7% of our cases, dysphagia in 1.7%, postoperative soft tissue swelling and hematoma in 1.7%, and dural penetration in 1.7%. Additionally, esophageal perforation was observed in 0.9%, aggravation of preexisting myelopathy in 0.9%, symptomatic recurrent laryngeal nerve palsy in 0.9%, mechanical failure in 0.9%, and superficial wound infection in 0.9%. In the vast majority anterior cervical spine surgery-associated complications are minor, requiring no further intervention. Awareness, early recognition, and appropriate management, are of paramount importance for improving the patients' overall functional outcome.

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“…All duplicate articles, abstracts, review articles, and letters to the editor were excluded. [1][2][3][4][5]8,10,[13][14][15][16][17][18][20][21][22][23][60][61][62]64,65,[67][68][69][70][71][72][73][74][75] Title and abstract review was performed once the initial list of studies was generated (Fig. 1).…”

Section: Study Selectionmentioning

confidence: 99%

Esophageal perforation after anterior cervical spine surgery: a systematic review of the literature

Halani

Baum

Riley

et al. 2016

SPI

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OBJECTIVE Esophageal perforation is a rare but well-known complication of anterior cervical spine surgery. The authors performed a systematic review of the literature to evaluate symptomatology, direct causes, repair methods, and associated complications of esophageal injury. METHODS A PubMed search that adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines included relevant clinical studies and case reports (articles written in the English language that included humans as subjects) that reported patients who underwent anterior spinal surgery and sustained some form of esophageal perforation. Available data on clinical presentation, the surgical procedure performed, outcome measures, and other individual variables were abstracted from 1980 through 2015. RESULTS The PubMed search yielded 65 articles with 153 patients (mean age 44.7 years; range 14–85 years) who underwent anterior spinal surgery and sustained esophageal perforation, either during surgery or in a delayed fashion. The most common indications for initial anterior cervical spine surgery in these cases were vertebral fracture/dislocation (n = 77), spondylotic myelopathy (n = 15), and nucleus pulposus herniation (n = 10). The most commonly involved spinal levels were C5–6 (n = 51) and C6–7 (n = 39). The most common presenting symptoms included dysphagia (n =63), fever (n = 24), neck swelling (n = 23), and wound leakage (n = 18). The etiology of esophageal perforation included hardware failure (n = 31), hardware erosion (n = 23), and intraoperative injury (n = 14). The imaging modalities used to identify the esophageal perforations included modified contrast dye swallow studies, CT, endoscopy, plain radiography, and MRI. Esophageal repair was most commonly achieved using a modified muscle flap, as well as with primary closure. Outcomes measured in the literature were often defined by the time to oral intake following esophageal repair. Complications included pneumonia (n = 6), mediastinitis (n = 4), osteomyelitis (n = 3), sepsis (n = 3), acute respiratory distress syndrome (n = 2), and recurrent laryngeal nerve damage (n = 1). The mortality rate of esophageal perforation in the analysis was 3.92% (6 of 153 reported patients). CONCLUSIONS Esophageal perforation after anterior cervical spine surgery is a rare complication. This systematic review demonstrates that these perforations can be stratified into 3 categories based on the timing of symptomatic onset: intraoperative, early postoperative (within 30 days of anterior spinal surgery), and delayed. The most common source of esophageal injury is hardware erosion or migration, each of which may vary in their time to symptomatic manifestation.

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Sternocleidomastoid Muscle Flap in Esophageal Perforation Repair After Cervical Spine Surgery

Cited by 41 publications

References 58 publications

Successful Management of Cervicoesophageal Anastomosis Leak After Microsurgical Esophageal Reconstruction

Successful Management of Cervicoesophageal Anastomosis Leak After Microsurgical Esophageal Reconstruction

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Esophageal perforation after anterior cervical spine surgery: a systematic review of the literature

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