Department of Vascular Surgery, Sir Gangaram Hospital, New Delhi, India.
Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
World J Surg Oncol. 2021 Dec 20;19(1):349. doi: 10.1186/s12957-021-02470-5.
Previous studies on sternocleidomastoid flaps, have defined the importance of preserving sternocleidomastoid (SCM) branch of superior thyroid artery (STA). This theory drew criticism, as this muscle is known to be a type II muscle, i.e., the muscle has one dominant pedicle (branches from the occipital artery at the superior pole) and smaller vascular pedicles entering the belly of muscle (branches from STA and thyrocervical trunk) at the middle and lower pole respectively. It was unlikely for the SCM branch of STA to supply the upper and lower thirds of the muscle. We undertook a cadaveric angiographic study to investigate distribution of STA supply to SCM muscle.
It is a cross-sectional descriptive study on 10 cadaveric SCM muscles along with ipsilateral STA which were evaluated with angiography using diatrizoate (urograffin) dye. Radiographic films were interpreted looking at the opacification of the muscle. Results were analyzed using frequency distribution and percentage.
Out of ten specimens, near complete opacification was observed in eight SCM muscle specimens. While one showed poor uptake in the lower third of the muscle, the other showed poor uptake in the upper third segment of muscle.
Based on the above findings we suggest to further investigate sternocleidomastoid muscle as a type III flap, as the STA branch also supplies the whole muscle along with previously described pedicle from occipital artery. However, this needs to be further corroborated intra-operatively using scanning laser doppler. This also explains better survival rates of superior thyroid artery based sternomastoid flaps.
先前关于胸锁乳突肌皮瓣的研究，已经定义了保护甲状腺上动脉（STA）的胸锁乳突肌（SCM）分支的重要性。这一理论引起了批评，因为众所周知，这块肌肉是 II 型肌肉，即肌肉有一个主要的蒂（发自枕动脉的上极），较小的血管蒂分别在中下部进入肌肉的腹部（发自 STA 和甲状颈干）。STA 的 SCM 分支不太可能供应肌肉的上三分之一和下三分之一。我们进行了一项尸体血管造影研究，以调查 STA 供应 SCM 肌肉的分布。
这是一项关于 10 具尸体胸锁乳突肌及其同侧 STA 的横断面描述性研究，使用含 diatrizoate（urograffin）染料的血管造影进行评估。通过观察肌肉的显影来解读射线照片。使用频率分布和百分比进行结果分析。
在 10 个标本中，8 个 SCM 肌肉标本观察到近乎完全显影。一个标本在肌肉的下三分之一显示出吸收不良，另一个标本在肌肉的上三分之一段显示出吸收不良。
根据上述发现，我们建议进一步将胸锁乳突肌作为 III 型皮瓣进行研究，因为 STA 分支还与先前描述的枕动脉蒂一起供应整个肌肉。然而，这需要在术中使用扫描激光多普勒进一步证实。这也解释了基于 STA 的胸锁乳突肌皮瓣存活率更高的原因。
