Department of Otorhinolaryngology, Head and Neck Surgery, The University of Texas Health Science Center, Houston, TX.
J Craniofac Surg. 2021;32(2):765-767. doi: 10.1097/SCS.0000000000007007.
To explore the feasibility of an original surgical technique for head and neck oncologic reconstruction utilizing a pedicled osteocutaneous supraclavicular artery island flap (SCAIF) in a cadaver model.
Cadaver dissection, Review of literature.
Two fresh frozen cadavers, 1 male and 1 female, were used for the dissection. Prior to dissection, measurements were taken on length of clavicle and distance between clavicular articulations and mandibular landmarks with the head in a neutral position. The SCAIF flap was raised in a subfascial plane and a 4.0 cm partial thickness clavicular bone graft was harvested attached to the flap. The pedicle was identified and the length of the supraclavicular artery was noted. The skin paddle was tunneled into the floor of mouth and the bone was placed into a pre-cut 4.0 cm mandibular body defect and fixated with a 1.7 mm Stryker mandibular reconstruction plate.
The male cadaver clavicle measured 16.4 cm in length. The distance from the sternoclavicular joint (SC) to the angle and symphysis of the mandible was 15.3 cm and 15.0 cm, respectively. In this cadaver, the bony graft and the vascular pedicle was not of sufficient length to reach the mandibular defect after tracing the vascular pedicle to the thyrocervical trunk (TCT), which was 13.3 cm from the mandibular angle (MA). The female cadaver had an average clavicular length of 15.0 cm, SC to angle 10.5 cm and SC to symphysis 8.1 cm. The bony graft and the vascular pedicled effortlessly reached without tension, with TCT only 7.8 cm from the MA and allowed sufficient bone graft mobility for plating.
In this cadaveric model, a novel approach utilizing an osteocutaneous SCAIF was shown as a feasible reconstruction option for oromandibular defects in selected patients. This technique is limited by the anatomical relationship between the neck and vascular pedicle length. Viability could be determined by pre-operative measurements, where the clavicular length should be significantly greater than the distance from SC to MA.
探索利用带蒂锁骨下动脉岛状瓣（SCAIF）在尸体模型中进行头颈部肿瘤重建的原创手术技术的可行性。
尸体解剖，文献复习。
使用 2 具新鲜冷冻尸体，1 男 1 女，进行解剖。在解剖之前，对锁骨长度和锁骨关节与下颌骨标志之间的距离进行测量，头部保持中立位置。SCAIF 皮瓣在筋膜下平面抬起，并用皮瓣附着的 4.0cm 部分厚度锁骨骨移植物进行采集。识别蒂，并注意锁骨下动脉的长度。皮瓣被隧道到口腔底部，骨头被放入预先切割的 4.0cm 下颌体缺损中，并使用 1.7mm Stryker 下颌骨重建板固定。
男性尸体的锁骨长度为 16.4cm。从胸锁关节（SC）到下颌角和下颌联合的距离分别为 15.3cm 和 15.0cm。在这具尸体中，在追踪血管蒂到颈总动脉（TCT）后，骨移植物和血管蒂的长度不足以到达下颌骨缺损，TCT 距离下颌角（MA）为 13.3cm。女性尸体的锁骨平均长度为 15.0cm，SC 到角 10.5cm，SC 到联合 8.1cm。骨移植物和血管蒂毫不费力地到达，没有张力，TCT 距离 MA 仅 7.8cm，为钢板提供了足够的骨移植物活动度。
在这个尸体模型中，一种利用骨皮 SCAIF 的新方法被证明是一种可行的选择，用于某些患者的口颌骨缺损重建。这种技术受到颈部和血管蒂长度的解剖关系限制。术前测量可以确定其可行性，其中锁骨长度应明显大于从 SC 到 MA 的距离。
