title: The role of the sternocleidomastoid muscle flap for esophageal fistula repair in anterior cervical spine surgery.
abstract: METHODS
  A retrospective study was undertaken which evaluated the medical records and imaging studies of a subset of patients managed by the spine service at Jackson Memorial Hospital who were diagnosed with an esophageal perforation in the setting of spinal surgery.
  
  
  OBJECTIVE
  To assess the safety and efficacy of a sternocleidomastoid muscle flap in the repair of esophageal perforation in the setting of anterior cervical spine surgery.
  
  
  BACKGROUND
  The management of an esophageal fistula in the setting of spine surgery is challenging and starts with a prompt and accurate diagnosis. In addition to broad spectrum intravenous antibiotics, several methods have been described to repair the fistula, which range from enteral tube feeding, direct repair, and/or repair with a local or free muscle flap.
  
  
  METHODS
  The review encompassed medical records, discharge summaries, operative reports, and imaging studies. Data were gathered with specific attention to demographics, primary pathology, mechanism of esophageal injury, method of spinal stabilization, method of esophageal repair, and time to initiation of oral intake. Follow-up interviews were conducted either in-person or by telephone.
  
  
  RESULTS
  Six patients were treated over the study period. There were 3 men and 3 women. The mean age was 52.8 years. Primary pathologies were penetrating trauma, blunt trauma (2 cases), degenerative disease (2 cases), and tumor. Mechanisms of esophageal injury were penetrating trauma, acute iatrogenic, chronic iatrogenic (3 cases), and intubation trauma. The time to diagnosis ranged from immediate to 10 months. The method of spinal stabilization was anterior autograft followed by posterior instrumentation in 4 of 6 patients. The method of esophageal repair was an inferiorly based sternocleidomastoid (SCM) flap in 4 cases, primary repair in 1 case, and esophageal diversion alone in 1 case. The time to oral intake averaged 59.2 days (range, 23-113 days) in those with a SCM flap versus 153.5 days (range, 119-188 days) in those treated without a flap.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurological Surgery, Jackson Memorial Hospital, University of Miami School of Medicine, Miami, FL, USA.
authors.forename: Ramon
authors.initials: R
authors.lastname: Navarro
authors.forename: Ramin
authors.initials: R
authors.lastname: Javahery
authors.forename: Frank
authors.initials: F
authors.lastname: Eismont
authors.forename: David J
authors.initials: DJ
authors.lastname: Arnold
authors.forename: Nitin N
authors.initials: NN
authors.lastname: Bhatia
authors.forename: Steve
authors.initials: S
authors.lastname: Vanni
authors.forename: Allan D
authors.initials: AD
authors.lastname: Levi
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D004937:Esophageal Fistula / Q000209:etiology* / Q000601:surgery*; D004939:Esophageal Perforation / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009334:Neck Muscles; D019637:Orthopedic Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome