title: Sternocleidomastoid muscle flap in esophageal perforation repair after cervical spine surgery: concepts, techniques, and personal experience.
abstract: METHODS
  A retrospective report was conducted on clinical and instrumental data of 3 patients treated for esophageal perforation after anterior cervical spine surgery.
  
  
  OBJECTIVE
  To define indications and evaluate the safety and effectiveness of surgical repair of esophageal perforations by means of sternocleidomastoid (SCM) muscle flap in the setting of anterior spinal surgery.
  
  
  BACKGROUND
  Esophageal perforation is an occasional or underreported complication in anterior cervical spine surgery. To prevent its potentially devastating and even life-threatening sequelae, prompt diagnosis and treatment are required. No treatment protocol has yet been standardized. In addition to conservative measures, several surgical approaches have been presented, ranging from primary repair to reconstruction with local, regional, or distant flaps.
  
  
  METHODS
  Primary spinal pathology and intervention, esophageal fistulae morphology, diagnostic work-up, clinical course, and surgical techniques for their repair are illustrated in each case. Follow-up data have been gathered by in-person visits.
  
  
  RESULTS
  Mean time from discovery of perforation to definitive surgical treatment institution was 44.3 days (range: 34 to 61 d). SCM muscle flap way used as reinforcement and protection of a primary esophageal suture in 2 cases and as a patch to the perforation in 1 case. All the fistulae healed without further complications. Mean time to oral feeding resumption was 17.6 days (range: 10 to 27 d) and mean hospitalization time was 19 days (range: 11 to 28 d). All the patients presented with a free oral diet at the last follow-up check.
  
  
  CONCLUSIONS
  Esophageal perforation treatment has to be multidisciplinary and tailored on each individual case. SCM muscle flap, used as reinforcement of a primary suture or as a patch to the lesion, has proved to be effective as definitive treatment for persisting or recurring esophageal fistulae after anterior cervical spine surgery. In this setting, conservative treatments may be inadequate or may actually perpetuate the condition.
authors.affiliation: Department of Otorhinolaryngology, IRCCS, S. Matteo Hospital Foundation, University of Pavia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Benazzo
authors.forename: Roberto
authors.initials: R
authors.lastname: Spasiano
authors.forename: Giulia
authors.initials: G
authors.lastname: Bertino
authors.forename: Antonio
authors.initials: A
authors.lastname: Occhini
authors.forename: Patrizia
authors.initials: P
authors.lastname: Gatti
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000601:surgery*; D004939:Esophageal Perforation / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods*; D012189:Retrospective Studies; D013247:Sternoclavicular Joint / Q000601:surgery; D013524:Surgical Flaps; D016896:Treatment Outcome