The compound sternal flap for laryngeal reconstruction

The authors present the successful transfer of a compound flap based on the sternocleidomastoid muscle in a patient who had undergone radiation therapy and a near-total laryngectomy. The surgical procedure, a one-stage reconstruction with a regional rotational flap, utilized a segment of the sternal periosteum and underlying anterior cortex attached to the sternal belly of the sternocleidomastoid muscle. The rigid wall provided by the flap over the temporary laryngeal endoprosthetic stent was an adequate replacement for the subtotally resected larynx, obviated the need for postoperative tracheostomy and nasogastric feeding, prevented collapse or stenosis of the airway, spared the voice, and provided an excellent functional result. This reliable flap presents a regional alternative to other local tissue transfers, such as epiglottic laryngoplasty, and more complicated microsurgical reconstructions.