Vascularized Clavicular Bone With Supraclavicular Artery Island Flap for Oromandibular Reconstruction
| Autor: | Jeffrey D. Johnson, Kunal Jain, Ron J. Karni, Syed Naqvi, Tang Ho |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
Symphysis Sternoclavicular joint Dissection (medical) Mandible Surgical Flaps 03 medical and health sciences 0302 clinical medicine Cadaver medicine.artery medicine Humans 030223 otorhinolaryngology Bone Transplantation business.industry 030206 dentistry General Medicine Anatomy Plastic Surgery Procedures medicine.disease Clavicle medicine.anatomical_structure Otorhinolaryngology Thyrocervical trunk Surgery Female Cadaveric spasm business |
| Zdroj: | The Journal of craniofacial surgery. 32(2) |
| ISSN: | 1536-3732 |
| Popis: | Objective 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. Method Cadaver dissection, Review of literature. Description 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. Results 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. Conclusion 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. |
| Databáze: | OpenAIRE |
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