前額皮弁の解剖学的研究

Abstract

The purpose of this study was to define the vascular pattern of the forehead flap and examine its possible future uses.Materials and Methods:Angiography: I used 10 cadavers (3 males, 7 females) which had been injected with contrast medium, and took the materials from these cadavers by resection at the pericranial superficial layer. After X-ray photographs and angiograms, I examined the vascular pattern. Then I split the material into the fascial layer and the cutaneous layer and examined the vascular pattern of each layer by the same method. I also examined the pattern of forehead flaps experimentally raised on the cadavers.Dye injection: I carried out this method on 18 sides of 16 patients during arterial catheterization for chemotherapy. The catheter was selectively inserted into the frontal branch of the superficial temporal artery and indigocalminum solution was injected as dye. After injecting 10ml of dye at a speed of 1ml/sec, the dyed area was recorded. Then another 10 ml was injected interrupting the adjacent arteries with digital pressure, and the dynamic change of the dyed areas was observed. The same method was carried out on a fresh cadaver and results were compared.Cadaver dissection: I studied anatomically the tissues related to the forehead flap.The results were as follows.1. The vascular pattern of each layer was characteristic.2. The vascular pattern of the superficial temporal artery was not a direct cutaneous artery, but was fasciocutaneous artery, and consequently forehead flap preserving the frontal muscle should be called a fasciocutaneous flap.3. I showed the anatomical territory of each artery by dye injection and this dynamically changed when the adjacent arteries were interrupted. This change clearly demonstrated the dynamic territory. The largest dynamic territory of the frontal branch included 6 anatomical areas.4. I examined the course of the superficial temporal artery and the temporal branch of the facial nerve within the temporoparietal fascia, and demonstrated the differences in its course between the layers.5. I investigated the distribution of the facial nerve and the superficial temporal artery. As a result of this study, I could demonstrate the landmarks for raising flaps without facial nerve injury.6. By preserving the frontal muscle and the frontal branch of the facial nerve, past cosmetic and functional disadvantages could be improved.