Friedman M, Mayer A D
Department of Otolaryngology and Bronchoesophagology, Rush Medical College, Rush University, Rush-Presbyterian-St Luke's Medical Center, Chicago, IL 60612.
Ann Otol Rhinol Laryngol. 1992 Nov;101(11):897-908. doi: 10.1177/000348949210101104.
Subglottic or tracheal reconstruction may be required in cases of subglottic stenosis, invasive thyroid carcinoma, or trauma. The sternocleidomastoid myoperiosteal flap uses clavicular periosteum on a muscle pedicle to provide vascularity. Clavicular periosteum is fibrous and durable and will conform to the shape of the trachea, forming bone to provide stability to the airway. The procedure is relatively simple and involves single-stage reconstruction. Success has been achieved in reconstruction of long-standing subglottic and/or tracheal stenosis and in cases of extreme tracheal defects. On the basis of 8 years' experience with this flap, we present the results from a series of 26 patients who underwent subglottic or tracheal reconstruction with the sternocleidomastoid myoperiosteal flap. Twenty-five of the 26 patients were successfully decannulated. Complications have been expanded to include one case of osteomyelitis of the sternum with mediastinitis, and 1 patient required revision. Subsequently, modifications of technique and patient management have been adopted. The complications compare favorably in frequency and in seriousness with those of other techniques for laryngotracheal reconstruction. We describe additional experience with this procedure and longer follow-up to establish its position as a first-line reconstructive approach for widespread clinical use.
声门下或气管重建可能适用于声门下狭窄、侵袭性甲状腺癌或外伤病例。胸锁乳突肌肌骨膜瓣利用带肌肉蒂的锁骨骨膜来提供血供。锁骨骨膜纤维性强且坚韧，能贴合气管形状，形成骨质以稳定气道。该手术相对简单，采用一期重建。在长期声门下和/或气管狭窄的重建以及极端气管缺损病例中均取得了成功。基于对该皮瓣8年的经验，我们展示了一系列26例行胸锁乳突肌肌骨膜瓣声门下或气管重建患者的结果。26例患者中有25例成功拔管。并发症已扩展至包括1例胸骨骨髓炎伴纵隔炎，1例患者需要翻修。随后，对技术和患者管理进行了改进。与其他喉气管重建技术相比，该并发症的发生率和严重程度更具优势。我们描述了该手术的更多经验以及更长时间的随访情况，以确立其作为广泛临床应用的一线重建方法的地位。
