The Role of the Sternocleidomastoid Muscle Flap for Esophageal Fistula Repair in Anterior Cervical Spine Surgery

Abstract

The use of an SCM flap for the repair of esophageal injury, in the setting of anterior cervical spine surgery, is a safe and effective tool. An SCM flap appeared to improve the time in initiating oral intake without any significant morbidity.

Pharyngoesophageal diverticulum: a delayed complication of anterior cervical spine surgery

“…Generally, after excision of the diverticulum, the primary closure of the esophagus should be reinforced by soft tissue. The most popular technique used is to employ the sternocleidomastoid muscle flap [18][19][20], but the consequences of this are increasingly apparent, such as lack of a clearly defined arterial blood supply, late oral intake, restricted motion, deformity of the neck, and potential damage to the sensory nerves [21]. Some practitioners have tried using alternate muscle flaps, such as the pectoralis major flap [11], infrahyoid muscle flaps [22], and omental muscle flaps [23].…”

Successful surgical management of a delayed pharyngo-esophageal perforation after anterior cervical spine plating

“…Plating has been reported to achieve a fusion rate up to 98%, resulting in early mobilization and reduced graft-related complications, especially in a multilevel fusion [2][3][4][5][6][7][8][9][10][11][12]. The overall complication rate is generally low, although the incidence is probably underestimated (range 5-20%).…”

“…Among them pharyngo-esophageal perforation is uncommon, but of utmost importance for the possibility of graft infection leading to osteomyelitis, medistinitis, sepsis and death. Its incidence is low and estimated between 0.02 and 1.49%, but its mortality is high ranging between 12 and 20% [3,4,7,[9][10][11][12].…”

“…Various etiologies have been identified: penetrating and non-penetrating trauma, iatrogenic surgical lesions and chronic erosion from synthesis devices, usually following migration [4,7,[9][10][11]. Occasional reports of esophageal perforation without plate displacement have been described and controversy exists about optimal management [6][7][8]11].…”

Letter to the Editor concerning “Infrahyoid muscle flap for pharyngeal fistulae after cervical spine surgery: a novel approach—report of six cases” (by R.O. Seidl et al.)

“…In a previous similar study, we presented our experience of using the SCM flap to reconstruct esophageal fistulae after anterior cervical spine surgery [1]. We also achieved closure of all the defects using this technique.…”