Sternocleidomastoid Muscle Flap Technique for Preventing Mediastinitis after McKeown Esophagectomy

ORIGINAL ARTICLE
Evgeniy A. Toneev

 
For citation: Toneev EA. Sternocleidomastoid Muscle Flap Technique for Preventing Mediastinitis after McKeown Esophagectomy. International Journal of Biomedicine. 2025;15(2):386-390. doi:10.21103/Article15(2)_OA19
 
Originally published June 5, 2025
 

Abstract: 

Background: McKeown esophagectomy is a common surgical approach for treating esophageal cancer, but it carries a considerable risk of cervical anastomotic leakage. This complication may lead to descending mediastinitis and other serious infections.
>This study aims to evaluate the effectiveness of using the medial head of the sternocleidomastoid muscle (SCM) flap as a physical barrier to prevent anastomotic leakage from spreading into the posterior mediastinum.
Methods and Results: Anatomical and biomechanical models were developed to evaluate the vascular supply, mobility, and mechanical integrity of the SCM flap. A prospective clinical study was conducted in 17 patients undergoing McKeown esophagectomy using this technique. Anatomical modeling confirmed that the SCM flap could be mobilized and rotated without tension, allowing stable coverage of the anastomosis. Computational analysis showed even stress distribution and minimal tissue displacement (≤2.3 ± 0.4 mm) during respiratory motion, indicating reliable fixation. Clinically, no cases of mediastinal contamination occurred. In all patients with leakage, the technique effectively localized the complication, preventing spreading to the mediastinum.
Conclusion: The use of the medial head of the sternocleidomastoid (SCM) flap effectively prevents descending mediastinitis and pleural empyema in cases of cervical anastomotic leakage following McKeown esophagectomy.

Keywords: 
McKeown esophagectomy • cervical anastomotic leakage • descending mediastinitis • pleural empyema • sternocleidomastoid muscle flap • postoperative complications
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Received February 19, 2025.
Accepted April 23, 2025.
©2025 International Medical Research and Development Corporation.