Transverse cervical artery fasciocutaneous free flap for head and neck reconstruction: initial anatomic and dye studies.

METHOD: The bilateral transverse cervical arteries of 16 fresh cadavers were exposed by an infraclavicular midline approach. Each artery was cannulated, and methylene blue dye was infused to delineate the skin territory subserved by the vessel. The two major infusion skin patterns obtained allowed fashioning of a thin fasciocutaneous flap incorporating supraclavicular skin, which was based on the transverse cervical artery; or a larger flap additionally incorporating upper back skin and varying amounts of trapezius muscle, when the artery had a dorsal scapular artery branch. Depending on the skin pattern, either scapula or clavicle could be transferred with the other soft tissues. RESULTS: The skin territory of the transverse cervical artery is caused to vary by the presence or absence of its dorsal scapular artery branch. The supraclavicular portion of the flap is recommended for repair of facial and nasal lesions because of its close match in color and texture to facial skin. Oral lesions can also be reconstructed with this flap because of its pliability. CONCLUSION: The free flap based on the transverse cervical artery pedicle appears to be a useful addition to the armamentarium of flaps for head and neck reconstruction. Clinical use of the flap is ongoing and will be subsequently reported.

Chordoma of the cranial base: the McGill experience.

Cranial base chrodoma, a rare, usually slow-growing tumour of bone thought to arise in notochord remnants, presents itself when its growth in the spheno-occiput results in cranial nerve compression or an obvious nasopharyngeal mass. The present review of 11 cases of cranial base chordoma encountered at three McGill University teaching hospitals from 1979 until 1992 examines presentation, radiologic findings, pathology, treatment, and outcome. A literature review surveys chrodoma with regard to epidemiology, diagnosis, efficacy of medical and surgical modalities on tumor control, and survival. Discussion focuses on current therapeutic options relative to histopathologic characteristics of chordoma, and whether or not these may be used to predict course of disease and outcome.