Branch Of Transverse Cervical Artery Research Articles

Clinical effects of flaps with cervical cutaneous branch of transverse cervical artery in repairing neck radiation ulcers

Objective: To explore the clinical effects of flaps with cervical cutaneous branch of transverse cervical artery in repairing neck radiation ulcer. Methods: The retrospective observational research was conducted. From January 2016 to December 2019, 8 cases with neck radiation ulcer were admitted to Guangzhou Red Cross Hospital of Jinan University and repaired with flaps based on cervical cutaneous branch of transverse cervical artery. There were 6 males and 2 females, aged 52-75 years. The ulcers occurred 14.5 years after radiotherapy on average, with ulcer areas of 5.0 cm×3.0 cm-7.0 cm×6.0 cm on admission. The wound areas were ranged from 6.0 cm×5.0 cm to 13.0 cm×6.5 cm after ulcers and fibrotic tissue around were resected. Seven cases underwent resection of flaps and wound repair operation on the first stage, and the other 1 case underwent pre-expansion of flap donor area on the first stage and resection of flap and wound repair operation on the second stage, with flap sizes of 8.0 cm×7.0 cm-15.0 cm×8.5 cm. The wounds in the donor areas of flaps in 7 patients were sutured directly, and the wound in the donor area of flap in the other 1 patient was repaired with thin split-thickness skin graft from thigh after being sutured partially. The preoperative ulcer tissue was collected for pathological examination, and the postoperative survival of the flaps and healing of the flap donor areas were observed. The flaps, the recurrence of the neck ulcers and neck function, and the scar hyperplasia in the donor areas of flaps were observed during follow-up. Results: Preoperative pathological examination of ulcer tissue showed that full-thickness necrosis occurred in ulcer skin, obvious fibrotic tissue hyperplasia, collagenization, and small-scale calcification in the base and surrounding tissue of the ulcers, and a large amount of chronic inflammatory cells and a small amount of acute inflammatory cells infiltration were observed in intercellular substance, which excluded the recurrence of tumor. All the flaps in 8 cases survived, the wounds were repaired effectively, and the postoperative donor areas of flaps healed well. During postoperative follow-up of 6-24 months, the flaps had good appearances without recurrence of ulcer, the movement function of neck was significantly improved, and no obvious scar hyperplasia was observed in the donor areas of flaps. Conclusions: Radiation ulcer in the neck is a serious long-term complication of neck after radiotherapy, which is difficult to heal with conservative treatment. The flap with cervical cutaneous branch of transverse cervical artery is close to the neck, with rich blood supply, constant anatomy, and is easy to cut. Neck radiation ulcers treated with the flaps showed good wound healing and improved functions, with no obvious scar hyperplasia.

Clinical effect of pre-expanded anterior perforator flap of transverse cervical artery and pre-expanded thoracic random flap in reconstructing extensive facial and cervical scar in relay

Objective: To explore the clinical effects of pre-expanded anterior perforator flap of transverse cervical artery in extensive facial and cervical scar reconstruction and contralateral pre-expanded thoracic random flap in relay in donor site repair. Methods: A retrospective cohort study was conducted. From May 2008 to December 2018, 10 patients with extensive facial and cervical scar after burns were treated in the Fourth Medical Center of PLA General Hospital, including 8 males and 2 females, aged 10-55 years. In the first stage of operation, two skin and soft tissue expanders of the same volume (with rated capacity of 250-600 mL) were respectively placed in the right side and left side of the chest according to the size of scar, and then the skin was expanded. The total amount of normal saline injected was 2 to 4 times of the rated capacity of the expander. In the second stage, the defect with area of 12 cm×8 cm-23 cm×15 cm caused by scar resection and release was repaired with unilateral pre-expanded anterior perforator flap of transverse cervical artery with area of 12 cm×9 cm-24 cm×16 cm. The contralateral pre-expanded thoracic random flap with the same area as that of the above-mentioned perforator flap was extended to repair the secondary defect with area of 8 cm×6 cm-17 cm×14 cm formed after transfer of the above-mentioned perforator flap. The exploration of perforating branch of transverse cervical artery, flap transfer and survival, injury repair, and complications were observed. The appearance and related function of donor and recipient sites and satisfaction of patients were followed up. Results: The perforating branches of transverse cervical artery appeared stably in the 10 patients. All the flaps were transferred to the recipient area without tension and survived. Both facial and cervical injuries were repaired successfully with no common complications. During the follow-up of 6 months-8 years, the color and texture of the pre-expanded anterior perforator flap of transverse cervical artery matched with the surrounding tissue, the functions of head raising and neck rotation of patients were significantly improved compared with those before operation, the color and texture of the flap transplanted in the first donor site matched with the original skin, linear scar left at the surgical incision, and 9 patients were satisfied with the restoration of the appearance and function of donor and recipient sites. Conclusions: The color and texture of the pre-expanded anterior perforator flap of transverse cervical artery match well with the face and neck, and the repairable area is large. After the perforator flap is removed, the secondary wound can be repaired with the pre-expanded thoracic random flap at the same time, and the injury of the chest donor site is alleviated. This relay repair method is a good choice for reconstructing extensive facial and cervical scar.

Supraclavicular Flap Reconstruction in Head and Neck Oncologic Surgery.

Free flaps have been considered as the gold standard for reconstruction of head and neck region after ablative oncologic surgery. However, the reconstructive surgeon's armamentarium should also involve pedicled flaps for certain situations such as patients having comorbid diseases necessiating shorter duration of surgical procedure. The supraclavicular flap is a pedicled thin fasciacutaneous flap used to reconstruct the defects in head and neck area. The flap has advantages of wide rotation of arc, easy matching with skin color of recipient area and relatively shorter flap harvesting time. Its bloods supply depends on supraclavicular artery which is a branch of transverse cervical artery. Between August 2016 and September 2019, the pedicled supraclavicular flap was used to reconstruct 17 head and neck cancers patients after ablative oncologic surgery. In 15 patients this flap was primary choice and in 2 patients it was used as a salvage reconstructive tool. Two of 17 flaps had very distal partial necrosis. There was no total loss of any flap. Flap harvesting time was always less than 1 hour. Mean duration for drainage tube removal at the donor side was 5 days. Functional outcomes were perfect. In our suggestion pedicled supraclavicular flap is a very good alternative option to free flap reconstruction especially for skin and oral cavity defects.

Trapezius flaps for reconstruction of head and neck defects following oncological resection – A systematic review

ObjectiveHead and neck (H&N) reconstruction after cancer resection is challenging. Myocutaneous trapezius flaps provide an alternative reconstruction for patients not suitable for microvascular free tissue transfer. MethodsA systematic review was performed on studies involving trapezius flaps for H&N reconstruction post oncological resection between the years 1985–2015. Data extracted included patient numbers and demographics, operative technique and complications. Complication rates, for the study cohort, were calculated and a univariate analysis was preformed evaluating patient and flap-related risk factors. ResultsSeventeen studies met the inclusion criteria, with a total of 157 trapezius flaps. Intraoral defects were the most frequent recipient site (74.5%). The mean skin paddle width was 6.84 cm (range 3–15 cm) and length was 11.1 cm (range 4–25 cm). Type 2 (superficial branch of transverse cervical artery) accounted for 77.1% (118/153) of all trapezius flaps performed. The complication rate was 15.9%, with 15 reported flap related and 7 donor site complications. Skin paddle size, pedicle selection, primary versus salvage reconstruction and radiotherapy were not identified risk factors for complications. ConclusionTrapezius flaps are a reliable and versatile myocutaneous flap for both primary and salvage surgery reconstruction of H&N defects following oncological resection.

Reconstruction of postburn facial scar contracture deformity with expanded flap containing cervical cutaneous branch of transverse cervical artery

To observe the effect of expanded flap containing cervical cutaneous branch of transverse cervical artery (TCA) on reconstruction of postburn facial scar contracture deformity. Six patients with postburn facial scar contracture deformity, hospitalized from September 2011 to January 2016, with the scar area ranging from 12 cm×10 cm to 20 cm×15 cm, were reconstructed with expanded flap containing cervical cutaneous branch of TCA. One expander of 300 mL or 350 mL implanted in anterior pectoral area was injected for excessive expanding; one patient was conducted with expansion in both sides of the anterior pectoral area. The volume of expansion varied from 1 260 to 2 010 mL after 6 to 15 months. Two flaps were delayed for their poor blood supply. After expansion, the flaps with the area ranging from 20 cm×7 cm to 25 cm×9 cm were transferred with no tension to cover the wounds after scar excision. The donor site was closed directly. Three to four weeks later, the vascular pedicle was dissected combined with local reconstruct surgery. All the flaps survived, with two wounds suffered delayed healing. During the follow-up for 4 to 15 months, the flaps were thin and soft with good sensation and color close to the facial skin. Expanded flap containing cervical cutaneous branch of TCA is a good choice for reconstruction of postburn facial scar contracture deformity because of its good texture and color, thin thickness, as well as it can provide large avaliable area while causing less injury to the donor site.

Reconstruction of cica-contracture on the face and neck with skin flap and expanded skin flap pedicled by anterior branch of transverse cervical artery

A high-quality flap is necessary for repairing faciocervical scar contractures. The supraclavicular region and chest wall are the preferred choices for reconstruction. The supraclavicular island flap (SIF) pedicled by the transverse cervical artery (TCA) has been reported. Compared to the traditional SIF flap, another type of flap pedicled by the anterior perforator of transverse cervical artery (ap-TCA) is more convenient for transfer to the faciocervical area. In this article, we use this type of perforator flap and expanded perforator flap to repair the faciocervical contracture. In this study, 10 cases (deformity caused by burn or trauma to the face and neck sites) with an average age of 32 years-old, were treated by ap-TCA flap and this type of expanded flap. In between, the flap was pre-expanded for approximately 3 months prior to transfer in 6 patients. Another 4 cases did not want the expander because of the long duration required for saline filling and potential complications of the expander. Bilateral prefabricated flaps were designed in two female cases. All 12 flaps in 10 patients were transferred tension-free to the defects and no flap was lost. The size of the flap ranged from 12cm×8cm to 15cm×20cm. All 12 flaps survived completely. The donor sites were closed directly in the above 6 patients where an expander had been used and reconstructed by split skin graft in 4 patients where no expander had been employed. Through a mean time of 6 months' follow-up, only one female patient was disappointed with the cicatrix that presented on the upper polar skin of both breasts, the other 9 patients were satisfied with both recipient function and appearance. The color and the texture matched well with the recipient area. The ap-TCA flap and expanded ap-TCA flap can be considered reliable options for faciocervical deformities as it can be easily elevated and it matches well with faciocervical area in color. With regards to the expanded flap, we cannot only reconstruct the face and neck region, but also suture the donor site directly.

Clinical application of expanded flap based on the cutaneous branch of transverse cervical artery

To investigate the clinical application of expanded flap based on cutaneous branch of transverse cervical artery for reconstruction of cervical cicatricial contracture. Based on the clinical anatomy of cutaneous branch of transverse cervical artery flap, we design the corresponding subclavicular area for expansion. The incision was usually located at the anterior axillary fold, 5-8 cm in length. The expander was implanted under the deep fascial layer, without injury of the vascular pedicle. Fixation sutures were put about 1 cm apart from the incision to prevent the expander from transposition and exposure. After expansion, the cervical cicatricial contracture was excised and released. According to the defect, the expanded flap based on the cutaneous branch of transverse cervical artery was designed, with the pedicle located at the posterior margin of sternocleidomastoid and 1. 8 cm above median point of clavicle. "S" shape incision was made at the location of vascular pedicle. Subcutaneous dissection was performed 1.5 cm in width along the incision on both sides. Then the flap was harvested under the deep fascial layer and rotated to cover defect without tension. It was not necessary to dissect the vascular pedicle further. The defect at donor site was closed directly. 17 cases were treated with the island flap. The contracture of the cervical scar was corrected completely with aesthetic appearance. Expanded flap based on cutaneous branch of transverse cervical artery has reliable blood supply. It' s an ideal flap for the treatment of cervical cicatricial contracture.

Applied anatomy of supraclavicular artery island flap and preliminary clinical report on reconstruction of tongue

To study the anatomy of supraclavicular artery island flap and report the clinical application of the island flap for the reconstruction of tongue defects. The branch, origination, course, length and diameter of transverse cervical artery and supraclavicular artery were observed on 20 flaps of 10 adult cadavers perfused with lead oxide-gel, and the draining veins were also observed. The supraclavicular artery island flaps were used to reconstruct the defects following tongue cancer ablation in 4 patients, and the data concerning functional impairment, aesthetic outcome and donor site morbidity were analyzed. The transverse cervical artery were originated from the thyrocervical trunk or subclavical artery, and separated into deep branch and superficial branch above the middle third of the clavicle. The supraclavicular artery were originated from superficial branch of the transverse cervical artery and extended to backward and outward, and run over surface of trapezius, acromial end of clavicle and deltoid fascia, and then penetrated the deep fascia and go into skin and subcutaneous tissue of supraclavicular and shoulder regions. The distance between the origins of the supraclavicular and transverse cervical arteries was on average 4.3 cm, and the distance between the origin of supraclavicular artery and the point where it penetrated the deep fascia was on average 3.6 cm. The external diameter of the transverse cervical artery was on average 2.7 mm, and the external diameter of supraclavicular artery was on average 1.1 mm. Two supraclavicular comitant veins ran adjacent to the supraclavicular artery and drained into the transverse cervical vein and external jugular vein respectively. In the clinical study, 3 flaps survived completely and part of the skin paddle of the flap in one case exhibited necrosis. The contour and function of tongues were restored well and there was no limitation of shoulder motion in all 4 cases. The supraclavicular artery island flap with supraclavicular artery as nutrient vessel is reliable for reconstruction of oral, maxillofacial and neck defects, and it can be used as a free flap equipped with the transverse cervical artery.

Repair of cervical scar contracture with expanded island flaps based on cervical cutaneous branch of transverse cervical artery

Objective To explore an ideal surgical treatment for cervical sear eontraeture. Methods From January, 2005 to December, 2008, 11 eases of cervical sear contraeture (Ⅱ-Ⅲ) were treated with the expanded flaps based on the cervical cutaneous branch of transverse cervical artery. At the first step, one or two soft tissue expanders were implanted beneath the skin at the clavicular-pectoral region. At the second step, after fully expanding, an expanded clavicular-pectoral flap that based on the cervical cutaneous branch of transverse cervical artery was designed and raised completely according to cervical cutaneous defect. And then, the flap was transferred to reconstruct the defect in cervix. The donor area was closed directly or covered with graft. Results The 11 cases were performed with unilateral flaps based on the cervical cutaneous branch of transverse cervical artery. No necrosis occurred. And the cervical contour and function have been mended. All of them had been followed up for 6-18 months with satisfactory results. Conclusions This procedure can be very useful for the plastic and reconstruction surgeons who are confronted with a difficult case of cervical scar contracture. By this means, a lot of materials of reparation with similar color, and texture can be obtained. And this method is simple, safe, and effective. Key words: Expanded flaps; Transverse cervical artery; Repair; Cervical scar contracture

The extra-long artery-pedicled back fascia skin flap for treatment of cervical contractive scar

Severe cervical scar contractive after burn is best repaired with a flap for the neck maximal function restoration. The trapezius myocutaneous flap is a common one to be used for this purpose. However, the traditional technique is usually not appreciated to transfer the flap to the opposite side of the neck in one stage. The delayed procedures are usually needed. In this paper, an extra-long back fascia flap pedicled with descending branch of transverse cervical artery was developed to restore the whole cervical contractive scar after burn in only one operation. With our experience of 25 patients, the flap was usually formed as large as 10-14 cm wide (18-20 cm in expanded cases) and 35-45 cm long, as twice long as that formed by the traditional technique, and easily reaching the opposite side of the neck. Finally, the flaps were successfully transferred to repair the full neck in only one-stage procedure after the cervical scars were excised, except for two cases with partial necrosis in the flap tip. But the wounds were closed with further advancing the flap in secondary operation. In the end all of the patients were completely repaired. The result indicates that the extra-long back fascia flap pedicled with descending branch of transverse cervical artery could be formed long enough to reach the opposite side of the neck and safely transferred to neck in one stage.