Fedzhaga I. P., Kravets O. V., Pivtorak V. I., Bulko I. V., Pivtorak K. V.

ANATOMICAL AND FUNCTIONAL CHARACTERISTICS OF COMPLEX FLAPS OF THE SUBCLAVIAN ARTERY BASIN IN RECONSTRUCTIVE SURGERY OF THE HEAD AND NECK

---

Show/Download

About the author:

Fedzhaga I. P., Kravets O. V., Pivtorak V. I., Bulko I. V., Pivtorak K. V.

Heading:

MORPHOLOGY

Type of article:

Scientific article

Annotation:

The article presents the anatomical variations of the blood vessels supplying the muscles that are clinically important for the safe performance of surgical procedures such as skin-muscle flap reconstruction. Because much of the discussion revolves around the arterial anatomy of muscles, venous drainage is often overlooked. However, a possible cause of flap loss may be impaired venous drainage. Purpose: to consider the anatomical variants of branching of the vessels of the subclavian artery and to investigate the peculiarities of the blood supply of the skin part of the skin-muscle flap of the sternocleidomastoid muscle in the experiment. It was established that the anatomical variants of the branches of the subclavian artery and the common carotid artery determine the vascularization of skin-muscle flaps. The study showed that the blood supply of the skin part of the skin-muscle flap goes beyond the projection of the sternocleidomastoid muscle, provided that the perforators of the upper thyroid artery are preserved. The obtained data are important in reconstructive and restorative surgery of the head and neck for a clear understanding of the limits of the guaranteed blood supply of the specified flap.

Tags:

Bibliography:

1. Popieluszko P, Henry BM, Sanna B, Hsieh WC, Saganiak K, Pękala PA, et al. A systematic review and meta-analysis of variations in branching patterns of the adult aortic arch. J Vasc Surg. 2018 68(1):298-306.e10. DOI: 10.1016/j.jvs.2017.06.097.
2. Khmara TV, Bazik NО, Lopushniak LY. Suchasni uiavlennia pro variantnu anatomiiu hilok duhy aorty (ohliad literatury). Bukovinian Medical Herald. 2016;20(3):219-223. [in Ukrainian].
3. Murashov OV. Variantnaya anatomiya arteriy, othodyaschih ot dugi aortyi, i ih vetvey (po dannyim preparirovaniya trupov, operativnyih vmeshatelstv i sovremennyiz metodov issledovaniya). Vestnik Avitsennyi. 2023;25(3):400-413. DOI: 10.25005/2074-0581-2023-25-3-400- 413.
4. Diaz B, Meneses E, Kinslow K, McKenney M, Elkbuli A, Boneva D. A rare case of a blunt thoracic aortic injury in a patient with an aberrant right subclavian artery: A case report and literature review. Int J Surg Case Rep. 2021;79:172-177. DOI: 10.1016/j.ijscr.2021.01.017.
5. Mirande MH, Durhman MR, Smith HF. Anatomic Investigation of Two Cases of Aberrant Right Subclavian Artery Syndrome, Including the Effects on External Vascular Dimensions. Diagnostics (Basel). 2020;10(8):592. DOI: 10.3390/diagnostics10080592.
6. Sparks DS, Wagels M, Taylor GI. Bone reconstruction: A history of vascularized bone transfer. Microsurgery. 2018;38(1):7-13. DOI: 10.1002/micr.30260.
7. McCarty JL, Corey AS, El-Deiry MW, Baddour HM, Cavazuti BM, Hudgins PA. Imaging of Surgical Free Flaps in Head and Neck Reconstruction. AJNR Am J Neuroradiol. 2019;40(1):5-13. DOI: 10.3174/ajnr.A5776.
8. Amiraliev KN, Ragimov ChR, Amiraslanov AT, Amiraliev NM. Nadklyuchichny`j kozhno-fasczial`ny`j loskut v rekonstrukczii opukholevy`kh defektov kozhi chelyustno-liczevoj oblasti. Journal of oral medicine and craniofacial research. 2022;3(3):6-10. DOI: http://dx.doi. org/10.5281/zenodo.7113895.
9. Fedzhaga IP, Kravets OV, Shamrai VA, Pivtorak VI, Fedzhaga OP, Plakhotniuk IM, et al. Shkirno-fastsialnyi klapot baseinu nadkliuchychnoi arterii v rekonstruktyvnii khirurhii holovy ta shyi. Zaporozhye medical journal. 2019;21(1):129-136. DOI: 10.14739/2310-1210. 2019.1.155859. [in Ukrainian].
10. Nasr HY, Friedlander P, Chiu ES. Supraclavicular Artery Island Flap for Head and Neck Oncologic Reconstruction: 15-year Experience, Past, Present, Future. Plast Reconstr Surg Glob Open. 2023;11(6):e5052. DOI: 10.1097/GOX.0000000000005052.
11. Kravets OV, Fedzhaga IP, Pivtorak VI, Fedzhaga OP, Bulko IV. Performance status and quality of life after reconstructions of buccal mucosal and retromolar trigone defects by skin and fascial flaps in oncologycal patients. Wiadomości Lekarskie. 2020;73(7):1510-1515. DOI: 10.36740/WLek 202007137.
12. Kumar N, Paul VS, Bhat KMR, Aithal AP. Bilateral variation in the branching pattern of the subclavian artery: an unusual finding with clinical implications. J Vasc Bras. 2023;22:e20220147. DOI: 10.1590/1677-5449.202201472.
13. Bordoni B, Varakallo M. Anatomy, head and neck, temporomandibular joint. Treasure Island, Florida: StatPearls Publishing; 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538486/.
14. Matsuura N, Sakuma H, Shimono A. Method to prevent cheek depression using an island sternocleidomastoid muscle flap with the middle pedicle as a feeding vessel in immediate reconstruction of the facial nerve with the sural nerve following resection of a parotid gland tumor. Arch Plast Surg. 2021;48(2):213-216. DOI: 10.5999/aps.2020.00668.
15. Nofal AA, Mohamed M. Sternocleidomastoid Muscle Flap after Parotidectomy. Int Arch Otorhinolaryngol. 2015;19(4):319-24. DOI: 10.1055/s-0035-1549155.
16. Zaid AM, Elzahaby IA, Abdallah A, Elalfy AF, Metwally IH, Ahmed WMS, et al. Reconstruction of Oromandibular Defect After Tumor Resection by Sternomastoid-clavicular Flap. Journal of Craniofacial Surgery. 2021;32(5):1845-1849. DOI: 10.1097/SCS.0000000000007231.
17. Zhang X, Zhao R, Wang G, Chen Y, Ding P, Yang X, et al. Island sternocleidomastoid myocutaneous flap for posterior pharyngeal wall defect repair after anterior cervical spine surgery. Int Wound J. 2022;19(1):169-177. DOI: 10.1111/iwj.13612.
18. Srivastava A, Kumar T, Pandey SK, Shukla RC, Pai E, Pandey M. Sternocleidomastoid flap for pedicled reconstruction in head & neck surgery- revisiting the anatomy and technique. World J Surg Oncol. 2021;19(1):349. DOI: 10.1186/s12957-021-02470-5.
19. Liu DY, Tian XJ, Li C, Sun SS, Xiong YH, Zeng XT. The sternocleidomastoid muscle flap for the prevention of Frey syndrome and cosmetic deformity following parotidectomy: A systematic review and meta-analysis. Oncol Lett. 2013;5(4):1335-1342. DOI: 10.3892/ol.2013.1179.
20. Wang W, Cai Y, Oranges CM, Kalbermatten DF, Schaefer DJ, Yang C, et al. Sternocleidomastoid Muscle Transfer for Treatment of Longstanding Facial Paralysis: Long-term Outcomes and Complications. In Vivo. 2022;36(1):501-509. DOI: 10.21873/invivo.12731.
21. Zhernov AO, Kovalenko OM, Zhernov OA. Application of vascularized perforant flaps in the hand restoration in electro-thermic affections. Klinicheskaia khirurgiia. 2020;87(11-12):71-75. DOI: 10.26779/2522-1396.2020.11-12.71.
22. Tenekeci G. Perforator flaps: principles and techniques. Issues in Flap Surgery. London: IntechOpen; 2018. DOI: 10.5772/intechopen.71270.
23. Fatani B, Alabood AA, Alkhayatt NM, Alzahrani HH, Al-Safadi A. Facial Reconstruction Using Sternocleidomastoid (SCM) Flap: A Review of the Literature. Cureus. 2023;15(2):e34575. DOI: 10.7759/cureus.34575.
24. Khazaeni K, Rajati M, Shahabi A, Mashhadi L. Use of a Sternocleidomastoid Myocutaneous Flap Based on the Sternocleidomastoid Branch of the Superior Thyroid Artery to Reconstruct Extensive Cheek Defects. Aesth Plast Surg. 2013;37:1167-1170. DOI: https://doi. org/10.1007/s00266-013-0216-z.
25. Chen HC, Chang HS. The sternocleidomastoid flap for oral cavity reconstruction: extended indications and technical modifications. Journal of Oral and Maxillofacial Surgery. 2015;73(12):2429-2439. DOI: https://doi.org/ 10.1016/j.joms.2015.07.027.

Publication of the article:

«Bulletin of problems biology and medicine», 2024 Issue 2, 173, 403-408 pages, index UDC 617.51+617.53):616.13+616-089.844

DOI:

10.29254/2077-4214-2024-2-173-403-408