PP161: Applications for the sternocleidomastoid perforator flap

Abstract

The conventional pedicled sternocleidomastoid (SCM) flap is a type II flap with a segmental vascular supply. It has a poor arc of rotation, limited volume and precarious vascularity. The author recently described a new technique for raising a SCM flap in which the flap has been fully mobilised by division of the upper and lower attachments of the muscle and is based solely on the perforating vessels of the superior thyroid vascular pedicle. This presentation reviews our experience with the SCM perforator flap. A case series based on a contemporaneous database over the last 3 years. All patients were managed for oral malignancy. The indications included; the patient was not suitable for free tissue transfer or pectoralis major flap, there was often substantial comorbidity, previous surgical and/or radiotherapy treatment, or recurrent disease. A conventional transverse cervical incision was preferred and most flaps were myocutaneous. The skin paddle was positioned directly over the mid to lower half of the SCM muscle. Minimal excision of proximal and distal muscle tissue was undertaken and the defect closed directly. The results of at least 10 patients will be presented. The greatly increased arc of rotation allowed placement in the floor of the mouth or tongue without tension. On one occasion there were no suitable vessels so a conventional superiorly based rotational flap was utilised. All perforator flaps survived without complication and functioned satisfactorily. The perforator flap is based on the dominant vessels (superior thyroid artery and/or branches of the external carotid artery) which supply the middle third. It may safely be used to reconstruct small to medium size defects of the oral cavity even when there has been previous surgical and/or radiotherapy providing there is a suitable perforating vessel. This technique is also a logical development of the increasing utilisation of perforator flaps to minimise donor site morbidity.