ABSTRACT
Objective To introduce a safe and practical approach for the treatment of severe muscular torticollis. Methods In an axis of the spasmodic sternocleidomastoid muscle, the author designed a five-valve flap with two valvae inside, which ended at the mastoid point and inferior clavicular part of sternocleidomastoid muscle, respectively. The arm length of each valve was approximately half of its axis. Each valve was separated bluntly in naked eyes in order not to detach the platysma myoides from the skin, and to release the webbed neck. Under the flap, the thinned and fibrosed sternocleidomastoid muscle and spasmodic neck sheath and superficial cervical vein were easily found. The sternocleidomastoid muscle was disconnected at the median point, and the two ends were retracted, the superficial cervical vein was cut and ligated, the neck sheath was released to uncover the spasmodic cervical artery and nerve. The head was right positioned, and then the surrounded fascial tissues were released under the protection of the arteries and veins. The flap was sutured to cover the arteries, veins and muscles. Results Reasonably good effect was achieved in one case and intermediate effects in other 4 cases. Surgical results were satisfactory. All the flaps were survival with insignificant scar formation. Conclusions Webbed skin deformity in the neck can be corrected by using five-valve plastic surgery of platysma myoides, which is able to cover the exposed nerves and vessels. This procedure prevents the adhesion of the operated area, ensures the blood supply of the distal portion of the flap, and also avoids the damage of other tissues in the flap area.