Cordova Adriana, Pirrello Roberto, D'Arpa Salvatore, Jeschke Johannes, Brenner Erich, Moschella Francesco
Palermo, Italy; Paris, France; and Innsbruck, Austria From the Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo; the Laboratoire d'Anatomie, Université R. Descartes; and the Department of Plastic and Reconstructive Surgery, Innsbruck Medical University, and the Division for Clinical-Functional Anatomy, Department of Anatomy, Histology and Embryology, Innsbruck Medical University.
Plast Reconstr Surg. 2008 Nov;122(5):1399-1409. doi: 10.1097/PRS.0b013e3181891651.
The supraclavicular skin has been studied extensively and used as a pedicled flap for face and neck reconstruction. Its use as a free flap has not paralleled its use as a pedicled flap. The authors performed an anatomical investigation to assess the possibility of harvesting a free supraclavicular flap with the donor-site scar lying in the supraclavicular crease. In this article, the authors present the results of their anatomical study together with the preliminary clinical applications.
Skin vascularization and feasibility of a free supraclavicular perforator flap were studied on 25 cadavers (15 fresh cadavers injected with colored latex at the Universiteé René Descartes in Paris; and 10 formalin-fixed, noninjected cadavers at the Innsbruck Medical University). The flap was used in two patients at the Plastic Surgery Department of the University of Palermo for a cutaneous facial reconstruction and intraoral reconstruction after cancer excision.
An average of four perforators were consistently found in the supraclavicular area coming from the transverse cervical artery. Venous perforators drain into the superficial venous plexus rather than into the venae comitantes of the transverse cervical artery. Two flaps were successfully used based on these vessels.
The vascularization of the supraclavicular skin depends on skin perforators coming from the transverse cervical artery and draining into the superficial venous plexus. Based on these vessels, a reliable free supraclavicular flap seems to be safe to harvest, with the scar hidden in the supraclavicular crease. The preliminary clinical applications of such a flap gave promising results, suggesting its potential applications.
锁骨上皮肤已得到广泛研究,并被用作带蒂皮瓣用于面部和颈部重建。其作为游离皮瓣的应用并不像作为带蒂皮瓣那样广泛。作者进行了一项解剖学研究,以评估切取供区瘢痕位于锁骨上皱襞的游离锁骨上皮瓣的可能性。在本文中,作者展示了他们的解剖学研究结果以及初步的临床应用情况。
在25具尸体上研究了游离锁骨上穿支皮瓣的皮肤血管化情况及可行性(15具新鲜尸体在巴黎笛卡尔大学注射了彩色乳胶;10具在因斯布鲁克医科大学用甲醛固定且未注射的尸体)。该皮瓣在巴勒莫大学整形外科的两名患者中用于面部皮肤重建和癌症切除后的口腔内重建。
在锁骨上区域平均可始终发现4支来自颈横动脉的穿支。静脉穿支汇入浅静脉丛,而非颈横动脉的伴行静脉。基于这些血管成功使用了两个皮瓣。
锁骨上皮肤的血管化依赖于来自颈横动脉并汇入浅静脉丛的皮肤穿支。基于这些血管,切取可靠的游离锁骨上皮瓣似乎是安全的,且瘢痕可隐藏在锁骨上皱襞内。这种皮瓣的初步临床应用取得了令人满意的结果,表明了其潜在的应用价值。