title: Sternocleidomastoid myofascial flap for reconstruction after composite resection of invasive squamous cell carcinoma of the tonsillar region: technique and outcome.
abstract: OBJECTIVE
  To present the surgical technique and determine the efficacy of sternocleidomastoid myofascial (SCMF) flap reconstruction after composite resection with intent to cure.
  
  
  METHODS
  Retrospective review of 73 consecutive patients with a previously isolated and untreated moderately to well-differentiated invasive squamous cell carcinoma of the tonsillar region and a minimum of 3 years follow-up, managed at a tertiary referral care center during the years 1970 to 2002, with an ipsilateral superiorly based SCMF flap after composite resection.
  
  
  METHODS
  The surgical procedure is presented in detail. Potential technical pitfalls are highlighted. Survival, mortality, and morbidity are documented. Univariate analysis for potential correlation between the incidence for postoperative flap complications and various variables is also performed.
  
  
  RESULTS
  The 1, 3, and 5 year Kaplan-Meier actuarial survival estimates were 82.2%, 64.4%, and 49.3%, respectively. Death never appeared to be related to the completion of the SCMF flap. Thirty-three (45.2%) patients had some kind of significant postoperative surgical complication, and nine (12.3%) patients had some kind of significant postoperative medical complication. The most common significant postoperative complication was partial SCMF flap necrosis and pharyngocutaneous fistula noted in 30.1% and 10.9% of patients, respectively. Complete SCMF flap necrosis was never encountered. No patient developed carotid artery rupture or died as a result of the SCMF flap, and none required additional surgery. In univariate analysis, no significant statistical relation was noted between the significant postoperative surgical complications related to the use of the SCMF flap and the variables under analysis.
  
  
  CONCLUSIONS
  The superiorly based SCMF flap appears to be simple to perform and useful for reconstruction of defects after composite resection.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Université René Descartes-Paris V, HEGP, AP-HP, Paris, France. ollivier.laccourreye@hop.egp.aphp.fr
authors.forename: Ollivier
authors.initials: O
authors.lastname: Laccourreye
authors.forename: Madeleine
authors.initials: M
authors.lastname: Ménard
authors.forename: Eva
authors.initials: E
authors.lastname: Behm
authors.forename: Dominique
authors.initials: D
authors.lastname: Garcia
authors.forename: Régis
authors.initials: R
authors.lastname: Cauchois
authors.forename: F Christopher
authors.initials: FC
authors.lastname: Holsinger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D012008:Recurrence; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000473:pathology; D014067:Tonsillar Neoplasms / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome