Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Department of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
J Shoulder Elbow Surg. 2018 Sep;27(9):1664-1671. doi: 10.1016/j.jse.2018.02.069. Epub 2018 May 8.
Irreparable rotator cuff tears (IRCTs) are a challenging problem with diverse treatment modalities. We propose a technique for the treatment of IRCTs in which a vascularized dermal autograft is transferred to the posterosuperior region of the rotator cuff using the supraclavicular artery (SCA) island flap.
Dissection of 11 fresh cadavers (19 shoulders) was performed, and the SCA island flap was harvested in all specimens. A full-thickness posterosuperior rotator cuff defect was created, and the flap was tunneled under the acromion and secured into position over the defect using multiple suture anchors. Simulated flap perfusion was then assessed, and flap measurements were recorded.
There were 4 male and 7 female cadavers (19 shoulders). Flap perfusion was assessed in 10 shoulders. On average, the flap thickness was 4.7 mm (range, 3.5-7.1 mm); width, 32.6 mm (range, 25.5-38.0 mm); and length, 169.2 mm (range, 132.0-235.0 mm). The average distance from the flap tip to the Neviaser portal was 76.2 mm (range, 48.0-99.6 mm), and that from the flap tip to the anterolateral acromial edge was 54.1 mm (range, 29.5-75.1 mm). The pedicle-to-footprint distance was 113.7 mm (range, 88.5-147.0 mm). The average flap length exceeded the pedicle-to-footprint distance by 55.5 mm (range, 43.5-88.0 mm), indicating adequate excursion of the flap. All flaps demonstrated adequate simulated perfusion after fixation.
The SCA island flap may be an option for a vascularized dermal autograft for IRCTs, as shown in this cadaveric study. This illustrates a possible technique with vascular viability.
不可修复的肩袖撕裂（IRCT）是一个具有多种治疗方式的具有挑战性的问题。我们提出了一种使用锁骨下动脉（SCA）岛状皮瓣将带血管的真皮移植物转移到肩袖后上区域的治疗 IRCT 的技术。
对 11 具新鲜尸体（19 个肩部）进行了解剖，并在所有标本中采集了 SCA 岛状皮瓣。创建了一个全层肩袖后上缺损，皮瓣经肩峰下隧道，并使用多个缝线锚钉将其固定在缺损处。然后评估皮瓣的模拟灌注情况，并记录皮瓣的测量值。
共有 4 名男性和 7 名女性尸体（19 个肩部）。评估了 10 个肩部的皮瓣灌注情况。平均而言，皮瓣厚度为 4.7mm（范围，3.5-7.1mm）；宽度为 32.6mm（范围，25.5-38.0mm）；长度为 169.2mm（范围，132.0-235.0mm）。皮瓣尖端至 Neviaser 入路的平均距离为 76.2mm（范围，48.0-99.6mm），皮瓣尖端至肩峰前外侧边缘的距离为 54.1mm（范围，29.5-75.1mm）。蒂至足迹的距离为 113.7mm（范围，88.5-147.0mm）。皮瓣长度平均超过蒂至足迹的距离 55.5mm（范围，43.5-88.0mm），表明皮瓣有足够的活动度。所有皮瓣在固定后均显示出足够的模拟灌注。
在这项尸体研究中，SCA 岛状皮瓣可能是不可修复的肩袖撕裂带血管真皮移植物的一种选择。这说明了一种具有血管生存能力的可能技术。
