1. STERNOCLEIDOMASTOID FLAP
FEATURES
Lateral and oblique in the neck
2 bellies
Course from manubrium and clavicle
(head and medial 1/3) to
occipital bone
(mastoid process and superior nuchal line)
5 X 18 cm

2. STERNOCLEIDOMASTOID FLAP
MOTOR NERVE
spinal portion of XI and 2sd and 3rd cervical nerves
enter proximal portion of posterior muscle belly
FUNCTION
head rotation and bending
expendable if remaining neck muscles are functionnals

3. STERNOCLEIDOMASTOID FLAP
VASCULAR ANATOMY
type II of Mathes and Nahai
Dominant pedicle:
branch of occipital artery (D)
enters on deep surface of upper 1/3 of muscle belly
(3 cm x 1 mm)

4. STERNOCLEIDOMASTOID FLAP
VASCULAR ANATOMY
3 minor pedicles:
branch of posterior auricular artery (m1; 2cm x 0.6 mm;
close to mastoid insertion)
branch of superior thyroid artery (m2; 2 cm x 0.6 mm;
distal 1/3 of anterior muscle belly)
branch of suprascapular artery
(m3; 2 cm x 0.5 mm;
posteriorly near clavicular origin) m1 D m2 m3

5. STERNOCLEIDOMASTOID FLAP
FLAP TYPE
muscular or
musculocutaneous
osseomusculocutaneous
POINT AND ARC OF ROTATION
Based on the dominant pedicle:
level of carotid bifurcation;
anterior neck and lower face (anterior rotation)
posterior neck and occipital area (posterior rotation)

6. STERNOCLEIDOMASTOID FLAP
ARC OF ROTATION
Distally based flap:
middle and lower neck

7. STERNOCLEIDOMASTOID FLAP
MUSCULOCUTANEOUS FLAP
SKIN TERRITORY
anterolateral skin of the neck located over the muscle
6 x 20 cm
coverage of intraoral and lower facial defects
SCM

8. STERNOCLEIDOMASTOID FLAP
FLAP MODIFICATIONS
osseomusculocutaneous flap
with the entire or partial medial third of the clavicle
(mandibular reconstruction)
also
functional muscular flap
(facial reanimation)

9. STERNOCLEIDOMASTOID FLAP
APPLICATIONS
Coverage:
anterior neck, posterior neck
lower face, midlateral face
oral cavity
occipital scalp
Reconstruction:
mandible
facial reanimation

10. STERNOCLEIDOMASTOID FLAP
GUIDELINES FOR FLAP ELEVATION
Patient position:
Lying on back with head turned to opposite side
Markings :
Mastoid, clavicle, suprasternal notch
Skin islands:
Standard flap: over the distal muscle closed to its origin
Distally based flap: over the upper proximal muscle closed to its insertion

11. STERNOCLEIDOMASTOID FLAP
GUIDELINES FOR FLAP ELEVATION
Pedicle location:
Dominant pedicle: on deep surface of upper 1/3 of muscle
Distal pedicle: deep to lower 1/3 of muscle

12. STERNOCLEIDOMASTOID FLAP Incisions:
GUIDELINES FOR FLAP ELEVATION
Incisions:
Skin island isolated
Muscle exposed through transverse neck incision or vertical incision

13. STERNOCLEIDOMASTOID FLAP
FLAP ELEVATION TECHNIQUES
STANDARD FLAP
Origin is divided
More distal pedicle is divided
Muscle is elevated from clavicle toward superior neck
Remaining segmental pedicle are divided
Dissection continues up toward dominant pedicle
Dominant pedicle is identified and preserved
XIth cranial nerve is preserved
Dissection is completed at level of hyoid bone

14. STERNOCLEIDOMASTOID FLAP
FLAP ELEVATION TECHNIQUES
DISTALLY BASED FLAP
Muscle outlined by drawing a line from mastoid to manubrium
Incision along that line and muscle identified
Muscle divided at midway along its length
Muscle mobilized from above toward distal pedicle

15. STERNOCLEIDOMASTOID FLAP
FLAP ELEVATION TECHNIQUES
VASCULARIZED BONE
Clavicle is cut with a saw, preserving the attachments of the origin of the muscle from the bone
Distal pedicle is identified and ligated
The combined flap is dissected from below upward

16. STERNOCLEIDOMASTOID FLAP
EXTENSION OF PEDICLE LENGHT
rotation arc increases with
release of insertion of SCM or
extension of skin island inferior to clavicle for 1 or 2 cm
TRANSPOSITION
Tunnelled under mandible for intraoral reconstruction

17. STERNOCLEIDOMASTOID FLAP
DONOR SITE CLOSURE
Directly
PRECAUTIONS
Spinal nerve: passing through SCM at upper and middle 1/3 junction
Internal jugular vein: closed to SCM at its origin
Great auricular nerve: closed to anterosuperior border of SCM

18. RECONSTRUCTIVE SURGERY PRINCIPLES, ANATOMY AND TECHNIQUES S J MATHES
F NAHAI
CHURCHILL LIVINGSTON EDS
1997