The Sternocleidomastoid Rotational Flap Decreases Great Vessel Exposure in Total Laryngectomy

Monday, October 13, 2025

4:24 PM - 4:30 PM EDT

Location: 127

Introduction: Complications following total laryngectomy (TL) can include pharyngocutaneous fistula, great vessel exposure, and catastrophic hemorrhage. The sternocleidomastoid (SCM) rotational flap was introduced by our institution in 2019 to reduce great vessel exposure and the risk of catastrophic hemorrhage. This study evaluates whether the SCM flap decreases the need for secondary vessel coverage surgery in TL patients.

Methods: A retrospective cohort study was conducted on 445 patients who underwent TL between September 2017 and August 2023. Data collected included patient demographics, comorbidities, surgical details, and postoperative outcomes. Patients were divided into two cohorts based on whether the SCM rotational flap was used during TL. The requirement for secondary vessel coverage was analyzed using Pearson’s Chi-Square and Fisher’s exact test, as appropriate, with a significance threshold of p < 0.05.

Results: The SCM flap was used in 177 (39.8%) of 445 patients. Overall, surgeries for great vessel exposure occurred in 31 (7.0%) patients and were significantly less frequent in the SCM group compared to the non-SCM group (1.7% vs. 10.4%, p < 0.001). Among patients with fistulas, secondary vessel coverage surgery rates were also lower in the SCM group (10.3% vs. 22.9%, p = 0.166), indicating a clinically meaningful benefit despite not reaching statistical significance. No significant differences in postoperative complications, including bleeding, infection, hematomas, and fistula formation, were observed between groups.

Conclusions: The SCM rotational flap is a simple and effective technique for protecting the great vessels during TL, significantly reducing the need for secondary vessel coverage surgery. These findings support the routine use of the SCM flap in TL procedures, with further research needed to validate these results in larger cohorts.

Presenting Author(s)

BB

Brenton T. Bicknell, BS

Medical Student
UAB Heersink School of Medicine, University of Alabama at Birmingham
Birmingham, AL, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Jessica L. Bishop, MD

Resident
University of Alabama at Birmingham
Birmingham, AL, United States

Disclosure information not submitted.
AC

Alice A. Carey, BS

Medical Student
UAB Heersink School of Medicine, University of Alabama at Birmingham
Mobile, AL, United States

Disclosure information not submitted.
NK

Nicolaus D. Knight, MS

Clinical Data Specialist
Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
Pinson, AL, United States

Disclosure information not submitted.
William T. Reed, MD, MPH

Attending
Maine Medical Partners
Portland, ME, United States

Disclosure information not submitted.
Andrew R. Fuson, MD

Assistant Professor
University of Alabama Medical Center
Birmingham, AL, United States

Disclosure information not submitted.
HJ

Hari Jeyarajan, MD

Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, United States

Disclosure information not submitted.
KW

Kirk Withrow

Disclosure information not submitted.
SM

Susan D. McCammon, MD PhD

professor
Department of Otolaryngology – Head and Neck Surgery, University of Alabama at Birmingham
Birmingham, AL, United States

Disclosure information not submitted.
Carissa M. Thomas, MD, PhD, FACS

Associate Professor
University of Colorado
Denver, CO, United States

Disclosure information not submitted.

Senior Author(s)

Benjamin J. Greene, MD

Associate Professor
Department of Otolaryngology—Head and Neck Surgery, University of Alabama at Birmingham
Homewood, Alabama, United States

Disclosure information not submitted.