Aberrant branches of the subclavian artery and their relationship with the phrenic nerve and the brachial plexus / Ramas aberrantes de la arteria subclavia y su relación con el nervio frénico y el plexo braquial

SUMMARY: Variations in subclavian artery branches are relatively common and may impact surgical procedures and effects. During educational dissection of a male cadaver, we encountered an extremely rare variation of the right subclavian artery branches. The internal thoracic artery, the thyrocervical trunk, and the costocervical trunk arose from the third part of the right subclavian artery. In addition, the phrenic nerve displaced remarkably laterally by the thyrocervical trunk, and the course of the costocervical trunk was between the upper trunk and the middle trunk of the brachial plexus. These variations may pose a potential risk for nerve compression and increase the risk of arterial and nerve puncture. This case report would bring attention to the possibility of other similar cases, and early detection of these variations through diagnostic interventions is helpful to reduce postoperative complications.

RESUMEN: Las variaciones en las ramas de la arteria subclavia son relativamente comunes y pueden afectar los procedimientos y efectos quirúrgicos. Durante la disección educativa de un cadáver masculino, encontramos una variación extremadamente rara de las ramas de la arteria subclavia derecha. La arteria torácica interna, el tronco tirocervical y el tronco costocervical nacían de la tercera parte de la arteria subclavia derecha. Además, el nervio frénico se desplazaba lateralmente por el tronco tirocervical, y el trayecto del tronco costocervical se encontraba entre el tronco superior y el tronco medio del plexo braquial. Estas variaciones pueden suponer un riesgo potencial de compresión nerviosa y aumentar el riesgo de punción arterial y nerviosa. Este reporte de caso llamaría la atención sobre la posibilidad de otros casos similares, y la detección temprana de estas variaciones a través de diagnósticos es útil para reducir las complicaciones postoperatorias.

The differences and relations between subclavicular flap and supraclavicular flap pedicled by branches of transverse cervical artery / 中华整形外科杂志

The anterior chest is an excellent donor site for cervicofacial reconstruction. Studies of chest flaps began as early as 1988 in xijing Hspital. We created a new flap called the subclavicular flap, which was pedicled by the thoracic branch of supraclavicular artery. This flap shares the similar vascular territory of the deltopectoral flap and is mainly used for reconstruction of cervicofacial wounds. The supraclavicular flap has the same vessel origin of supraclavicular flap but is pedicled by the different branch, the deltoid branch. Its vascular territory locates on the shoulder region. Therefore, many differences and relations exist between the two flaps and there are also some disputes. To enhance the understanding of the two flaps, presenting a summary on the two flaps, especially for their relations and differences.

Comparison of the clinical outcome of defect reconstruction after oral cancer resection using forearm flap and trapezius myocutaneous flap pedicled with the transverse cervical artery / 中华整形外科杂志

Objective@#To compare and analyze the effects of forearm flap and superior trapezius myocutaneous flap in repairing oral cancer defects.@*Methods@#56 cases of defect repair after oral cancer radical surgery were treated with the forearm flap (29 cases) and superior trapezius myocutaneous flap (27 cases). The success rate, postoperative quality of life and postoperative recovery time of the two groups were compared. The t-test was used for statistical analysis.@*Results@#The success rate of forearm flap group was 96.6%(28/29) compared to 96.3%(26/27) in the trapezius myocutaneous flap group (P=0.920). The postoperative recovery time was (9.4±2.7) d (forearm flap group) and (9.3±2.6) d (trapezius myocutaneous flap group), respectively (P=0.489). The score of postoperative quality of life was 576.3±76.2 (forearm flap group) and 568.4±79.3 (trapezius myocutaneous flap group), respectively (P=0.471). There was no significant difference in all comparisons (P>0.05).@*Conclusions@#The free forearm flap and the superior trapezius myocutaneous flap pedicled with the transverse cervical artery can be used to repair the oral cancer, and satisfactory function and ideal clinical effect can be achieved. Both two kinds of flaps have high success rate and good clinical practical value. The latter has little influence on the donor site, and can be used as the first choice.

Repair of cervical scar contracture with expanded island flaps based on cervical cutaneous branch of transverse cervical artery / 中华医学美学美容杂志

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.

Transverse Cervical Artery and Appropriate Veins as Recipient Vessels in Head and Neck Reconstruction

PURPOSE: The purpose of this study is to evaluate the transverse cervical artery of those who received preoperative radiotherapy or radical neck dissection and those who are unable to utilize the branch of external carotid artery system, which are most commonly used as recipient artery in head and neck reconstruction. METHODS: 10 patients were selected as head and neck cancer candidates for study. 8 patients received radical neck dissection or modified radical neck dissection and 3 patients underwent preoperative radiotheraphy. In call cases, reconstruction using free flap was performed with transverse cervical artery as recipient artery and posterolateral cervical vein or transverse cervical vein as recipient vein. RESULTS: Partial necrosis of flap due to wound infection was noted in one case and successful microsurgery was achieved in all other cases. The average pedicle length was 9.3cm and all arteries underwent end to-end anastomosis. In 7 patients, posterolateral cervical vein was used as recipient artery and transverse cervical vein was utilized in 3 patients. CONCLUSION: In cases where recipient artery from external carotid system cannot be utilized due to preoperative radiotherapy or radical neck dissection, the transverse cervical artery can be an alternative option of choice. Due to diverse variations of transverse cervical vein as a recipient vein, the posterolateral cervical vein may be considered in such cases.

Applied anatomy of superior trapezius myocutaneous and spina scapulae osteomyocutaneous flaps pedicled with transverse cervical artery / 实用口腔医学杂志

Objective:To study the anatomic basis of superior trapezius myocutaneous and spina scapulae osteomyocutaneous flaps pedicled with transverse cervical vessel.Methods:The blood vessels,the size of the superior trapezius muscle and the spina scapulae were dissected and examined in 32 adult corpses.Results:The superior trapezius muscle was in the shape of trapezium.The border length (mm) of A,B,C and D was 174.63,157.18,86.98 and 80.95 in average respectively.The area of the muscle was 126.78 cm2 on the average.The spina scapulae was 131.21 mm in average length.The length (mm) of transverse cervical artery trunk, superficial cervical artery trunk and its ascending artery,spina scapulae branch artery was 42.50,27.80,43.12,28.75 in average,their external diameter(mm) was 2.71,2.39,1.96 and 0.50 respectively.Entering the muscle,the ascending artery had 3～6 branches with the external diameter of 0.5 mm or more.The venous vessels were following the copartner artery.Conclusion:The superior trapezius muscle and the spina scapulae may be made for the myocutaneous and osteomyocutaneous flaps pedicled with transverse cervical artery used in oral and maxillofacial reconstruction.