The sternomastoid island myocutaneous flap for oral cancer reconstruction

To evaluate the usefulness of the sternomastoid island myocutaneous flap for reconstruction of defects after excision of oral cancer.

One hundred eleven superiorly based sternomastoid island myocutaneous flaps were used for one-stage primary reconstruction in 110 consecutive patients with oral cancer during a 53-month period from June 1985 to November 1989.

Ninety-eight patients had radiation therapy before surgery. One hundred six flaps were used for mucosal lining of the mouth and six flaps were used for providing skin cover. Flap-related complication developed in 38 patients (34.5%). Total flap loss occurred in eight patients (7.3%). Radical irradiation before surgery significantly increased flap-related complications. Low-molecular-weight dextran did not improve flap survival. After a minimum follow-up of 24 months, nine patients (8.2%) had recurrences in the ipsilateral neck. The flap could easily reach the oral cavity without producing tension on the suture line. The flap also did not produce excessive bulk in the mouth or on the face.

In a selected group of patients with a clinically N0 neck, the sternomastoid island myocutaneous flap is oncologically safe and it gives satisfactory cosmetic and functional results with no lasting morbidity.