Adams Austin S, Wright Mary J, Johnston Sean, Tandon Ravi, Gupta Neel, Ward Kenneth, Hanemann Cynthia, Palacios Enrique, Friedlander Paul L, Chiu Ernest S
Departments of Plastic & Reconstructive Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA.
Ann Plast Surg. 2012 Sep;69(3):312-5. doi: 10.1097/SAP.0b013e31822afaba.
The vascular anatomy of the supraclavicular artery island (SAI) flap has been investigated using both cadaveric anatomic dissections and angiographic studies. Accurate preoperative evaluation and localization of its vascular pedicle confirms its location, course, anatomic variation, and improves flap success. The objective of this report is to demonstrate the utility of multislice computed tomography (CT) angiography for confirming the presence of the vascular pedicle of the SAI flap when planning head and neck reconstruction.
Patients were studied using 64-multislice CT angiography (CTA) to localize the supraclavicular artery, including its origin and destination. Axial images, multiplanar reconstructions, and 3D volume-rendered images were analyzed on a Philips workstation. Radiologic image findings and clinical experience will be described.
SAI CT angiography was successfully performed in 15 patients (30 shoulders) ranging from ages 22 to 81 years. Accurate identification of the main vascular pedicle was achieved in 14/15 patients. Location, course, pedicle length, and anatomic variations were reported for 23 of 30 arteries. Mean vessel diameter was found to be 1.49 mm (range, 0.8-2.0 mm) on the right and 1.51 mm (range, 1.0-2.1 mm) on the left. The mean length of the artery was 38.3 mm on the right (range, 26.6-59.6 mm) and 38.4 mm on the left (range, 24.3-67.0 mm). In all patients, the supraclavicular artery originated off the transverse cervical artery-a branch of the thyrocervical trunk. Positioning of the patient's upper extremities at the side was helpful in the identification of the supraclavicular artery and its distribution. Contrast injection site should be contralateral to the side needed for the flap if sidedness is of importance, secondary to contrast bolus artifact.
Preoperative evaluation of the SAI flap with multislice computed tomography angiography is feasible in patients. A radiologic study protocol has been developed which improves the ability to detect this vessel. This technique provides a noninvasive approach to the identification of the vascular anatomy and is easily standardized/reproducible. The identification of the vascular pedicle and its anatomy can be a benefit to the surgical team during preoperative design of the SAI flap; however, clinical experience confirming these radiologic findings will be needed to optimize surgical outcome.
已通过尸体解剖和血管造影研究对锁骨上动脉岛状（SAI）皮瓣的血管解剖结构进行了研究。对其血管蒂进行准确的术前评估和定位可确定其位置、走行、解剖变异，并提高皮瓣移植的成功率。本报告的目的是证明多层螺旋计算机断层扫描（CT）血管造影在计划头颈部重建时确认SAI皮瓣血管蒂存在的实用性。
使用64层螺旋CT血管造影（CTA）对患者进行研究，以定位锁骨上动脉，包括其起源和终点。在飞利浦工作站上分析轴位图像、多平面重建图像和三维容积再现图像。将描述放射学图像结果和临床经验。
15例患者（30侧肩部）成功进行了SAI CT血管造影，年龄范围为22至81岁。14/15例患者成功识别出主要血管蒂。报告了30条动脉中23条的位置、走行、蒂长度和解剖变异。右侧平均血管直径为1.49mm（范围0.8 - 2.0mm），左侧为1.51mm（范围1.0 - 2.1mm）。右侧动脉平均长度为38.3mm（范围26.6 - 59.6mm），左侧为38.4mm（范围24.3 - 67.0mm）。在所有患者中，锁骨上动脉起源于颈横动脉——甲状腺颈干的一个分支。将患者上肢置于身体一侧有助于识别锁骨上动脉及其分布。如果皮瓣移植的侧别很重要，由于对比剂团注伪影，对比剂注射部位应与皮瓣所需侧别相反。
对患者进行多层螺旋CT血管造影对SAI皮瓣进行术前评估是可行的。已制定了一项放射学研究方案，可提高检测该血管的能力。该技术提供了一种无创识别血管解剖结构的方法，且易于标准化/重复。识别血管蒂及其解剖结构对手术团队在术前设计SAI皮瓣时有益；然而，需要临床经验来证实这些放射学发现，以优化手术效果。
