A Clinical Study On The Defect Reconstruction With Sternocleidomastoid Flap After Tumor Resection In The Oral And Maxillofacial Region

Purpose: To evaluate the clinical usage of sternocleidomastoid (SCM) flap for defect reconstruction after tumor resection in the oral and maxillofacial region and to investigate the factors which may affect the result of flap transplantationMethod: 40 patient underwent SCM flap reconstruction were reviewed and observed. The cases included 8 lingual carcinomas, 11 carcinoma of mouth floor. 3 buccal cancers. 10 carcinoma of gingiva, 3 carcinoma of parotid gland, and 5 malignant tumors in other position. All patients were reconstructed with SCM myocutaneous or muscular flap immediately after tumor resection. All flap's blood supply were based on the muscular branch of occipital vessel and the muscular branch of superior thyroid vessel. The maximum island flap was 8 × 8cm and the minimum was 3×4 cm.Result: Except for 2 total necrosis of the island skin, the other 38 SCM flaps succeeded. In 5 cases, partial distal epithelial necrosis was found, but healed and re-epitheliallized without further therapy. Three cases experienced submandibular infection and effusion, they recovered after drainage. The function of both recipient and donor sites was satisfied after operation. In 8 pathologically positive lymph node [PN (+)] cases, 1 case underwent neck lymph node carcinoma recurrence. In 24 pathologically negative lymph node [PN(-)] cases, 3 cases developed recurrence and 1 case died of distant metastasis.Conclusion: By reviewing the cases vand related literatures, it was demonstrated that the sternocleidomastoid flap suit to reconstruct small -to -medial defect after tumor recession in the oral and maxillofacial region. The operation procedure was relatively simple and convenient. The survive rate of the flap was fairly high, and the functional recovery was satisfied. To ensure the successful sternocleidomastoid myocutaneous reconstruction, the following is important: 1. Operate in a light and soft manner to prevent the skin flap rip from the muscle. 2. Preserve and properly anatomize the muscular branch pedicel from the occipital artery and the superior thyroid artery. 3. Rotating radius and angle should be sufficient, the muscle pedicle should not be compressed;4. The island flap should be sutured without any tension;5. Ligature should not be over tight or over gentle;6. Effective negative pressure drainage and oral hygiene caring. But there are also some disadvantages, such as the risk of remaining cancerous tissue in the flap, and the limitation of the flap size. Therefore the indication for the SCM flap should be strictly selected.