title: Sternohyoid flap for facial reanimation: a comprehensive preclinical evaluation of a novel technique.
abstract: OBJECTIVE
  Neuromuscular reanimation of the face provides the correct specific neural functional input and thereby prevents synkinesis. Unfortunately, this ideal situation is rarely encountered in the clinical setting.
  
  
  OBJECTIVE
  To assess the technical feasibility of and define the surgical procedure for harvesting the sternohyoid muscle as a novel free flap for use in facial reanimation indications.
  
  
  METHODS
  Fresh, postmortem, nonfixed cadavers were used to define the anatomy and perform the flap harvest procedures. Twenty-four flap harvests were performed. Angiography was performed on the pedicle of the harvested flaps to assess potential flap perfusion. Adenosine triphosphatase staining was performed on the muscle specimens to establish fiber type.
  
  
  METHODS
  The harvest technique, pedicle (arterial or venous), nerve length, and flap geometry parameters were characterized.
  
  
  RESULTS
  The sternohyoid muscle was found to be reliably vascularized by the superior thyroid artery in all cases with an appropriate arterial and venous pedicle for vascular anastomosis. The mean arterial (5.5 cm) and venous (5.9 cm) pedicle lengths are comparable with gracilis flaps. The mean motor nerve length was 10.7 cm. The inclusion of the hyoid bone allows rigid fixation, and the muscle size, fiber type, and volume profiles all compare favorably to the gracilis flap for use in the indication of facial reanimation. Mock surgical procedures were performed to define inset parameters. This flap potentially allows single-stage cross-facial neurorrhaphies to be performed.
  
  
  CONCLUSIONS
  This is the first article, to our knowledge, of the sternohyoid muscle as a potential donor site for free-tissue transfer. This muscle has a predictable vascular pedicle and neural innervation along with size and fiber type parameters that make it an ideal potential free flap for facial reanimation.
  
  
  METHODS
  NA.
authors.affiliation: Section of Facial Plastic and Reconstructive Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. alamd@ccf.org
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Alam
authors.forename: Timothy
authors.initials: T
authors.lastname: Haffey
authors.forename: Kalpesh
authors.initials: K
authors.lastname: Vakharia
authors.forename: Karthik
authors.initials: K
authors.lastname: Rajasekaran
authors.forename: John
authors.initials: J
authors.lastname: Chi
authors.forename: Richard
authors.initials: R
authors.lastname: Prayson
authors.forename: Jennifer
authors.initials: J
authors.lastname: McBride
authors.forename: Gordon
authors.initials: G
authors.lastname: McClennan
mesh_terms: D002102:Cadaver; D005145:Face / Q000601:surgery*; D005260:Female; D006801:Humans; D006928:Hyoid Bone / Q000601:surgery / Q000637:transplantation; D008297:Male; D018482:Muscle, Skeletal / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012680:Sensitivity and Specificity; D013249:Sternum / Q000601:surgery / Q000637:transplantation; D013524:Surgical Flaps / Q000098:blood supply* / Q000294:innervation*; D020858:Tissue and Organ Harvesting / Q000379:methods