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Lurin IA, Makarov VV, Khoroshun EM, Nehoduiko VV, Shypilov SA, Smolianyk KM. Features of the use of ladder myoplasty of a gunshot wound to the laryngopharynx: Case report. Int J Surg Case Rep 2023; 111:108875. [PMID: 37797522 PMCID: PMC10551620 DOI: 10.1016/j.ijscr.2023.108875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 09/24/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The laryngopharynx wound is considered to be one of the most severe wounds of neck both in war and in peace, as it may cause life threatening changes in the whole body (asphyxia, bleeding, shock). Important aspects of surgical treatment are to ensure full breathing, acceptable ways of feeding, and the use of reliable wound closure techniques aimed to prevent digestive tract failure and to maintain the framework and aerostasis of the laryngotracheal region. CASE PRESENTATION A case of unilateral multiple wounds of the laryngopharynx was described in the article. The features of diagnostics, surgical treatment and conservative therapy in the postoperative period with this injury were presented. The wounded man was urgently operated. During surgery the pharynx was mobilized. The metal fragment was removed. The wound of the pharynx was sutured with a two-row suture. The next stage of the surgical treatment was myoplasty. In the case of the patient, the purpose of myoplasty was additional sealing of the pharyngeal suture and myoplasty of the thyroid cartilage injury zone for the purpose of aerostasis. Because of the size of the wounds and their anatomical localization, we used the mobilized lower edge of the Musculus sternocleidomastoideus for myoplasty and proposed the method of ladder myoplasty developed by us. CLINICAL DISCUSSION In myoplasty method the following criteria must be followed: the muscle flap must be of sufficient length and width, so as not to cause excessive tension in the myoplasty area; the flap must be thick enough to avoid necrosis that may cause subsequent infectious complications; when taking the flap, the most sparing operative access should be used to avoid functional and anatomical disorders; the volume of the taken muscle flap must not lead to functional and anatomical disorders. CONCLUSION The proposed method of ladder myoplasty using Musculus sternocleidomastoideus is unique, and proves its high efficiency in unilateral multiple laryngopharyngeal injuries, and can be recommended for wide clinical implementation in such clinical situations.
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Affiliation(s)
- I A Lurin
- National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine; State Scientific Institution "Scientific and Practical Center of Preventive and Clinical Medicine" of the State Administration of Affairs, Kyiv, Ukraine
| | - V V Makarov
- Military Medical Clinical Center of the Northern Region, Kharkiv, Ukraine; Kharkiv National Medical University, Kharkiv, Ukraine
| | - E M Khoroshun
- Military Medical Clinical Center of the Northern Region, Kharkiv, Ukraine; Kharkiv National Medical University, Kharkiv, Ukraine
| | - V V Nehoduiko
- Military Medical Clinical Center of the Northern Region, Kharkiv, Ukraine; Kharkiv National Medical University, Kharkiv, Ukraine
| | - S A Shypilov
- Military Medical Clinical Center of the Northern Region, Kharkiv, Ukraine; Kharkiv National Medical University, Kharkiv, Ukraine
| | - K M Smolianyk
- Kharkiv National Medical University, Kharkiv, Ukraine.
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Moletta L, Pierobon ES, Salvador R, Volpin F, Finocchiaro FM, Capovilla G, Piangerelli A, Ciccioli E, Zanchettin G, Costantini M, Merigliano S, Valmasoni M. Pharyngo-Esophageal Perforation Following Anterior Cervical Spine Surgery: A Single Center Experience and a Systematic Review of the Literature. Global Spine J 2022; 12:719-731. [PMID: 33887971 PMCID: PMC9109565 DOI: 10.1177/21925682211005737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Case series and systematic review of the Literature. OBJECTIVES Pharyngo-esophageal perforation (PEP) is a rare, life-threatening complication of anterior cervical spine surgery (ACSS). Best management of these patients remains poorly defined. The aim of this study is to present our experience with this entity and to perform a systematic Literature review to better clarify the appropriate treatment of these patients. METHODS Patients referred to our center for PEP following ACSS (January 2002-December 2018) were identified from our database. Moreover, an extensive review of the English Literature was conducted according to the 2009 PRISMA guidelines. RESULTS Twelve patients were referred to our Institution for PEP following ACSS. Indications for ACSS were trauma (n = 10), vertebral metastases (n = 1) and disc herniation (n = 1). All patients underwent hardware placement at the time of ACSS. There were 6 early and 6 delayed PEP. Surgical treatment was performed in 11 patients with total or partial removal of spine fixation devices, autologous bone graft insertion or plate/cage replacement, anatomical suture of the fistula and suture line reinforcement with myoplasty. Complete resolution of PEP was observed in 6 patients. Five patients experienced PEP persistence, requiring further surgical management in 2 cases. At a median follow-up of 18.8 months, all patients exhibited permanent resolution of the perforation. CONCLUSIONS PEP following ACSS is a rare but dreadful complication. Partial or total removal of the fixation devices, direct suture of the esophageal defect and coverage with tissue flaps seems to be an effective surgical approach in these patients.
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Affiliation(s)
- Lucia Moletta
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Elisa Sefora Pierobon
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Renato Salvador
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy,Renato Salvador, Department of Surgical,
Oncological and Gastroenterological Sciences, University of Padova, Clinica
Chirurgica 3°, Via Giustiniani 2, 35128, Padova, Italy.
| | - Francesco Volpin
- Department of Neurosciences,
University Hospital of Padova, Unit of Neurosurgery, Via Giustiniani 2, Padova,
Italy
| | | | - Giovanni Capovilla
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Alfredo Piangerelli
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Eleonora Ciccioli
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Gianpietro Zanchettin
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Mario Costantini
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Stefano Merigliano
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
| | - Michele Valmasoni
- Department of Surgical, Oncological
and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°,
Via Giustiniani 2, Padova, Italy
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Srivastava A, Kumar T, Pandey SK, Shukla RC, Pai E, Pandey M. Sternocleidomastoid flap for pedicled reconstruction in head & neck surgery- revisiting the anatomy and technique. World J Surg Oncol 2021; 19:349. [PMID: 34930342 PMCID: PMC8690521 DOI: 10.1186/s12957-021-02470-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/05/2021] [Indexed: 12/21/2022] Open
Abstract
Background Previous studies on sternocleidomastoid flaps, have defined the importance of preserving sternocleidomastoid (SCM) branch of superior thyroid artery (STA). This theory drew criticism, as this muscle is known to be a type II muscle, i.e., the muscle has one dominant pedicle (branches from the occipital artery at the superior pole) and smaller vascular pedicles entering the belly of muscle (branches from STA and thyrocervical trunk) at the middle and lower pole respectively. It was unlikely for the SCM branch of STA to supply the upper and lower thirds of the muscle. We undertook a cadaveric angiographic study to investigate distribution of STA supply to SCM muscle. Methods It is a cross-sectional descriptive study on 10 cadaveric SCM muscles along with ipsilateral STA which were evaluated with angiography using diatrizoate (urograffin) dye. Radiographic films were interpreted looking at the opacification of the muscle. Results were analyzed using frequency distribution and percentage. Results Out of ten specimens, near complete opacification was observed in eight SCM muscle specimens. While one showed poor uptake in the lower third of the muscle, the other showed poor uptake in the upper third segment of muscle. Conclusion Based on the above findings we suggest to further investigate sternocleidomastoid muscle as a type III flap, as the STA branch also supplies the whole muscle along with previously described pedicle from occipital artery. However, this needs to be further corroborated intra-operatively using scanning laser doppler. This also explains better survival rates of superior thyroid artery based sternomastoid flaps.
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Affiliation(s)
- Apurva Srivastava
- Department of Vascular Surgery, Sir Gangaram Hospital, New Delhi, India
| | - Tarun Kumar
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
| | - Shashi Kant Pandey
- Department of Anatomy, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ram Chandra Shukla
- Department of Radiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Esha Pai
- Department of Surgical Oncology, Heritage Hospital, Varanasi, India
| | - Manoj Pandey
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Zhang X, Zhao R, Wang G, Chen Y, Ding P, Yang X, Zhao Z, Zhang Y. Island sternocleidomastoid myocutaneous flap for posterior pharyngeal wall defect repair after anterior cervical spine surgery. Int Wound J 2021; 19:169-177. [PMID: 33999495 PMCID: PMC8684854 DOI: 10.1111/iwj.13612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/19/2021] [Accepted: 04/27/2021] [Indexed: 12/04/2022] Open
Abstract
Injuries and tumours of the cervical spine represent therapeutic challenges to the treating surgeon due to the complex anatomical relationships and biomechanical features. The anterior cervical midline (ACM) and anterior cervical retropharyngeal (ACR) approaches are effective and safe surgical approaches for certain cervical spine lesions, such as cervical spine neoplasms, atlantoaxial subluxation, and certain odontoid fractures. Posterior pharyngeal wall defects (PPWDs) is one of the most frequently encountered surgical morbidities after anterior cervical spine surgery (ACSS). However, limited information has been published concerning effective approaches for PPWD reconstruction after ACSS. The manuscript aimed to describe a novel application of the island sternocleidomastoid myocutaneous flap (ISMF) in the management of PPWDs after ACSS, including surgery with the ACM approach and ACR approach. From April 2015 to November 2019, the clinical data of three patients with PPWDs repaired using the ISMF in Peking university third hospital were retrospectively analysed. The observational indexes are as follows: postoperative survival of the flap, wound healing 2 weeks after surgery, eating and pronunciation function 2 months after surgery. The above indexes of these three cases recovered well. Three patients did not have any persistent PPWD after repair with the ISMF and did not require any further surgical procedures related to the cervical spine.
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Affiliation(s)
- Xinling Zhang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Runlei Zhao
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Guanhuier Wang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Yujie Chen
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Pengbing Ding
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Xin Yang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Zhenmin Zhao
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Yuan Zhang
- Department of Otolaryngology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Assessment and treatment of hypopharyngeal and cervical esophagus injury: Literature review. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:489-492. [PMID: 32057697 DOI: 10.1016/j.anorl.2020.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Wounds and perforations of the upper gastrointestinal tract are serious and life-threatening. The hypopharynx and cervical esophagus, by their respective anatomical positions, are exposed to traumatic wounds, most often during diagnostic tests, but management such wounds remains a subject of discussion. The present article analyzes the current state of knowledge on epidemiology, etiologies, risk factors, diagnostic management, prognostic factors and available treatments.
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Revisiting the sternocleidomastoid flap as a reconstructive option in head and neck surgery. The Journal of Laryngology & Otology 2019; 133:742-746. [DOI: 10.1017/s0022215119001592] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackgroundThe sternocleidomastoid can be used as a pedicled flap in head and neck reconstruction. It has previously been associated with high complication rates, likely due in part to the variable nature of its blood supply.ObjectiveTo provide clinicians with an up-to-date review of clinical outcomes of sternocleidomastoid flap surgery in head and neck reconstruction, integrated with a review of vascular anatomical studies of the sternocleidomastoid.MethodsA literature search of the Medline and Web of Science databases was conducted. Complications were analysed for each study. The trend in success rates was analysed by date of the study.ResultsReported complication rates have improved over time. The preservation of two vascular pedicles rather than one may have contributed to improved outcomes.ConclusionThe sternocleidomastoid flap is a versatile option for patients where prolonged free flap surgery is inappropriate. Modern vascular imaging techniques could optimise pre-operative planning.
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