[Application of indocyanine green angiography in repair of facial soft tissue defect using superficial temporal artery based forehead flap].

Objective: To explore the feasibility of using indocyanine green angiography in mapping the superficial temporal vessels and assisting design and harvesting of the superficial temporal artery based forehead flap. Methods: A clinical data of 14 patients with facial soft tissue defects repaired with superficial temporal artery based forehead flaps between October 2015 and November 2022 was retrospectively analyzed. There were 9 males and 5 females with a median age of 9.5 years (range, 3-38 years). The forehead flaps were used to reconstruct facial soft tissue defects following excision of facial scar (8 cases) or congenital melanocyte nevus (6 cases). The size of defects ranged from 3 cm×2 cm to 24 cm×9 cm. Before operation, the indocyanine green angiography was used to map the superficial temporal artery and vein, and to analyze the relationship of the arteries and veins. The forehead flaps with unilateral superficial temporal fascia as the pedicle was transferred to repair the small facial defect in 2 cases. The facial pedicle contained the frontal branch of the superficial temporal artery and 2 cm of the superficial temporal fascia around the vessel, and the tiny accompanying vein of the frontal branch of the superficial temporal artery was used as the outflow of the flap. The forehead flaps with the skin pedicle including bilateral or unilateral superficial temporal fascia and the overlying skin was pre-expanded and transferred to repair the large facial defect in 12 cases. The skin pedicle contained the frontal branch of superficial temporal artery and one of main branches of superficial temporal vein. Among the 12 cases, the frontal branch of superficial temporal vein was used as the outflow in 4 cases, and the parietal branch was used as the outflow in 8 cases. The size of the flaps ranged from 3 cm×2 cm to 30 cm×13 cm. The skin pedicles were divided at 3 weeks after the flap transfer. Results: Indocyanine green angiography could clearly showed the course and branching of the superficial temporal artery and vein. Individual differences existed in the location where the frontal branch of the superficial temporal artery entered the forehead. The superficial temporal vein had great variability and did not follow the artery. One patient had expander-related complication, which resulted in 3-cm flap necrosis. The necrotic tissue was debrided and repaired with skin grafting. The other flaps totally survived and the incisions healed by first intention. All patients were followed up 2-24 months, with a median of 11.5 months. The color, texture, and thickness of the flaps matched well with those of recipient sites. Hypertrophic scar was not observed in recipient or donor site. All patients were satisfied with the reconstructive outcomes. Conclusion: Indocyanine green angiography can clearly visualize the course and the branches of the superficial temporal arteries and veins, which can help surgeons understand the position, distribution, and concomitant relationship of the superficial temporal vessels, and make a rational surgical plan of the forehead flap.

Cavernous sinus dural arteriovenous fistula embolized via a rare anastomosis between the facial vein and the superficial temporal vein.

A cavernous sinus dural arteriovenous fistula (CSdAVF) is an abnormal communication between the dural branches of the internal and external carotid arteries and the cavernous sinus. Transvenous embolization is the first choice to resolve CSdAVFs, and various venous access routes have been reported. However, transvenous embolization of a CSdAVF through a rare venous anastomosis between the facial and superficial temporal veins using a quadruple coaxial catheter system is scarce in the literature. A 30-year-old woman presented with a typical triad of CSdAVF that was supplied by the inferolateral and meningohypophyseal trunks and several dural branches of the external carotid artery. CSdAVF was solely draining through the right superior ophthalmic vein to the bilateral facial veins. The right facial vein had a rare anastomosis, with the superficial temporal vein terminating in the external jugular vein. Transvenous targeted embolization of CSdAVF was performed through the right superior ophthalmic vein. The rare anastomosis between the right superficial temporal vein and the right facial vein was used as the access route for CSdAVF. The quadruple coaxial catheter system was effective in overcoming the long and tortuous access route and stabilizing the movement of the microcatheter for target embolization. CSdAVF was successfully embolized with microcoils. This is the first report of a CSdAVF embolized via a rare anastomosis between the facial vein and the superficial temporal vein. A quadruple coaxial catheter system can overcome this unusual access route.

Application of indocyanine green angiography in repair of facial soft tissue defect using superficial temporal artery based forehead flap / 中国修复重建外科杂志

OBJECTIVE@#To explore the feasibility of using indocyanine green angiography in mapping the superficial temporal vessels and assisting design and harvesting of the superficial temporal artery based forehead flap.@*METHODS@#A clinical data of 14 patients with facial soft tissue defects repaired with superficial temporal artery based forehead flaps between October 2015 and November 2022 was retrospectively analyzed. There were 9 males and 5 females with a median age of 9.5 years (range, 3-38 years). The forehead flaps were used to reconstruct facial soft tissue defects following excision of facial scar (8 cases) or congenital melanocyte nevus (6 cases). The size of defects ranged from 3 cm×2 cm to 24 cm×9 cm. Before operation, the indocyanine green angiography was used to map the superficial temporal artery and vein, and to analyze the relationship of the arteries and veins. The forehead flaps with unilateral superficial temporal fascia as the pedicle was transferred to repair the small facial defect in 2 cases. The facial pedicle contained the frontal branch of the superficial temporal artery and 2 cm of the superficial temporal fascia around the vessel, and the tiny accompanying vein of the frontal branch of the superficial temporal artery was used as the outflow of the flap. The forehead flaps with the skin pedicle including bilateral or unilateral superficial temporal fascia and the overlying skin was pre-expanded and transferred to repair the large facial defect in 12 cases. The skin pedicle contained the frontal branch of superficial temporal artery and one of main branches of superficial temporal vein. Among the 12 cases, the frontal branch of superficial temporal vein was used as the outflow in 4 cases, and the parietal branch was used as the outflow in 8 cases. The size of the flaps ranged from 3 cm×2 cm to 30 cm×13 cm. The skin pedicles were divided at 3 weeks after the flap transfer.@*RESULTS@#Indocyanine green angiography could clearly showed the course and branching of the superficial temporal artery and vein. Individual differences existed in the location where the frontal branch of the superficial temporal artery entered the forehead. The superficial temporal vein had great variability and did not follow the artery. One patient had expander-related complication, which resulted in 3-cm flap necrosis. The necrotic tissue was debrided and repaired with skin grafting. The other flaps totally survived and the incisions healed by first intention. All patients were followed up 2-24 months, with a median of 11.5 months. The color, texture, and thickness of the flaps matched well with those of recipient sites. Hypertrophic scar was not observed in recipient or donor site. All patients were satisfied with the reconstructive outcomes.@*CONCLUSION@#Indocyanine green angiography can clearly visualize the course and the branches of the superficial temporal arteries and veins, which can help surgeons understand the position, distribution, and concomitant relationship of the superficial temporal vessels, and make a rational surgical plan of the forehead flap.

A previously unreported variant of the auriculotemporal nerve.

Venous fenestrations are rare and when present often are not pierced by regional nerves. Herein, we report an unusual case of a fenestrated superficial temporal vein (STV). Anterior to the external ear, where the STV and superficial temporal artery normally travel with the auriculotemporal nerve (ATN), the nerve was found to pierce the STV. The fenestration within the STV was approximately 0.35mm in diameter, and there was no sign of compression of the ATN as it traversed this vessel. Following the site of penetration of the STV by the ATN, the nerve had a normal course into the skin and surrounding fascia. To our knowledge, this is the first report of a fenestrated STV being pierced by the ATN. Such an anatomical variation might be considered by clinicians who treat patients with pathology of this region.

Pathology and Protein Changes of the Spinal Dural Arteriovenous Fistula Arterial Draining Vein Under Sustained High Vascular Pressure.

Object: Spinal dural arteriovenous fistula (SDAVF) is the most common spinal vascular shunt lesion. Although pathological changes in the SDAVF draining vein (SDAVF-DV) have been elucidated, protein changes remain enigmatic. We investigated the pathology and protein changes in the SDAVF-DV under sustained high vascular pressure. Methods: Three SDAVF-DV samples were compared with superficial temporal artery (STA) and superficial temporal vein (STV) samples as controls. Vascular structure was revealed by hematoxylin and eosin (H&E) and Masson staining; and cell distribution, extracellular matrix, and inflammation infiltration were observed by immunohistochemistry. Label-free quantitative proteomics was performed, and the peptide mixture was fractionated and analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) to identify differentially expressed proteins. Bioinformatics analysis of the differentially expressed proteins was performed using Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and protein-protein interaction (PPI) networks. Results: H&E and Masson staining showed an artery-like structure of the SDAVF-DV. Immunostaining showed that vWF+ cells were not continuous in the SDAVF-DV. Although α-SMA+ and AT1+ cells were more abundant in the STV than in the SDAVF-DV, piezo-1 expression was lower in the SDAVF-DV. The SDAVF-DV showed different distributions of elastin, COL I, and COL III. COL IV and COL VI were decreased in the SDAVF-DV, while CD45+ cells and COX-1 were increased compared with those in the controls. No differences in CD68 expression and COX-2 staining were observed between the SDAVF-DV and controls. Compared with the STA, 95 proteins were upregulated and 303 proteins were downregulated in the SDAVF-DV. The most differential GO terms in each category were the adenylate cyclase-modulating G protein-coupled receptor signaling pathway, U6 snRNP, and SH3 domain binding. The most differentially expressed KEGG protein pathway was focal adhesion. Compared with the STV, the SDAVF-DV had 158 upregulated proteins and 362 downregulated proteins. The most differential GO terms in each category were lamellipodium assembly, U6 snRNP, and SH3 domain binding; and the most differentially expressed KEGG protein pathway was dilated cardiomyopathy. PPI analysis revealed PPIs among the top 300 proteins. Conclusions: The SDAVF-DV exhibits specific pathology and protein expression changes under sustained high vascular pressure. The results of the present study provide insights into the pathogenesis of SDAVF formation at the protein level as well as a scientific foundation for further exploration of the pathophysiological mechanism of the SDAVF.

Pedicled temporoparietal fascial flap for combined revascularization in adult moyamoya disease.

Moyamoya disease (MMD) is a progressive, idiopathic cerebrovascular occlusive disease. Various revascularization techniques including direct, indirect, and combined microvascular bypasses have been described. This article presents a modified revascularization technique for MMD utilizing a pedicled temporoparietal fascial flap (TPFF) for combined revascularization. This technique combines a large area of coverage for indirect revascularization with the benefits of a direct bypass. The pedicled TPFF also benefits from intact venous drainage to minimize the risk of flap swelling that could result in complications from mass effect.

Novel variations in spatial relations between the facial nerve and superficial temporal and maxillary veins.

Variations in the relationship of the retromandibular vein to the facial nerve have been widely reported due to their relevance for surgical approaches in parotid, osteotomy and mandibular condyle surgery. In the context of the retromandibular retroparotid approach, remaining deep to the retromandibular vein is advised to decrease the likelihood of encountering the facial nerve during mandibular condyle surgery. In the present report, an unusual variant of the superficial temporal vein lying superficial to the facial nerve is described. This represents a variation of the venous branching pattern within the parotid gland, whereby the superficial temporal vein joins the maxillary vein inferior to its usual communication. These findings are discussed in the context of commonly used surgical approaches to the mandible for condylar trauma or osteotomy surgery.

Systemic Gene Therapy for Targeting the CNS.

Systemic gene delivery is useful for modeling and treatment of a body-wide disease. Recently, it has been shown that certain agents, when delivered systemically, can efficiently target the central nervous system. This technique has been used to model and treat rodent models of neurological disease with unprecedented success. Here, we describe intravenous delivery in neonate and adult mice. These techniques are easily learned and have minimal equipment requirements.

Abnormal Intraparotid Termination of Facial Vein and Its Clinical Importance

Facial vein is the main vein of the face. Though its origin is constant, it frequently shows variations in its termination. We report a rare type of variation of facial vein. The right facial vein coursed transversely across the masseter, superficial to the parotid duct and entered into the substance of the parotid gland, at its anterior border. Deep dissection of the gland revealed the abnormal termination of facial vein into the superficial temporal vein. The transverse facial vein drained into the facial vein. The superficial temporal vein after receiving the facial vein continued as retromandibular vein. Knowledge of this anomalous course and termination of facial vein may be important for the surgeons doing parotid, maxillofacial and plastic surgeries.

A Clinical Analysis of the Anatomy of the Superficial Temporal Vessels

The anatomy and distribution of the superficial temporal vessels are known to follow regular patterns, with few exceptions in previous studies. But these previous studies of the anatomy and distribution of the superficial temporal vessels were based, only on the cadaver studies. Authors evaluated the anatomy of these vessels in the operative field of the living body from December 1997 to June 2001, The superficial temporal vessels were surgically exposed from the zygomatic arch extending to the superior temporal line through a preauricular incision in 18 patients(20 cases), who underwent reconstructive surgery using these vessels in the operative field. The authors measured and analyzed; the distribution, branching and diameters of the superficial temporal vessels. The results were obtained as follows; 1.In 19 cases, STV(superficial temporal vein) runs posterior to STA(superficial temporal artery) at the upper border of the zygomatic arch. 2.There was no frontal or parietal branches in 2 cases and vena comitante existed along with STA in one case. 3.The external diameter of STA and STV was measured at the lower border of the zygomatic arch. The external diameter of STA ranged from 1.5mm to 3.0 mm(average 2.1mm) and those of STV ranged from 1.3mm to 3.5mm (average 2.0mm). This study can be helpful in the reconstructive surgery using the superficial temporal vessels, for the results of our study are based on the true anatomy of the living body.

Topographical Relationship of the Superficial Temporal Vessels and the Auriculotemporal Nerve / 대한해부학회지

The anatomy of the superficial temporal vessels and the auriculotemporal nerve is important when harvesting various skin flaps in the temporal region. But Anatomy textbooks describe only one pattern of topographical relationship between these structures. A total of 65 Korean cadavers with 121 sides were used. We examined the topographical relationship between the superficial temporal artery and vein and the auriculotemporal nerve. And the bifurcating location of the superficial temporal artery and its distance from the lamina tragi were measured. The running patterns of the superficial temporal vessels were classified into 4 types according to their distance from each other and their parallelism. The artery and vein run parallel to each other in 61.2%. The running patterns of the superficial temporal vessels were classified into 5 types according to their anterior and posterior relationship. The artery runs anterior to the vein in most of the cases (72.7%). The topographic relationships of the auriculotemporal nerve and the superficial temporal vessels were classified into 6 types according to their anterior, posterior, superficial or deep position. In this classification, the relationship between the artery and the vein was not considered. The frequencies of 6 types were within 10~20%. The bifurcation of the artery occurred above the zygomatic arch in 85.3%. The superficial temporal artery ran 5.1 mm anterior to the tragus.

THE MACRO-MICRO-ANATOMY OF THE VESSELS OF THE SKIN FLAP IN THE FRONTO-PARIETO-TEMPORAL REGION / 解剖学报

The vessels of the skin flap in the fronto-parieto-temporal region were studied by way of injecting 10% ethyl acetate dye into the artery of 25 Chinese adult cadavers.The main arterial supply in this region is the superficial temporal artery. In addition,the posterior auricular,supraorbital and supratrochtear arteries distribute over this region as well.The superficial temporal artery is the largest scalp artery.The area distributed by this artery amounts to 57.38?6.05% of the whole scalp.The frontal and parietal branches are the terminal branches of the superficial temporal artery.The former is a constant branch in our cases.It is a dominant vessel of which both the distributing area and the caliber are larger than the parietal branch.The superficial temporal vein is mainly formed by the union of a frontal and a parietal venous branches,which approximately accompany the corresponding branches of the artery. The arteries in the fronto-parieto-temporal region form rich anastomoses at the median area of the vertex.The large anastomoses channels were counted in this study.These channels have anatomically provided for the designing of a supe(?)long flap which run across the median zone.The forehead flap with the frontal branch as the pedicle artery and the scalp flap with the parietal branch as the pedicle artery were discussed.