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ZOR DURUMLARDA ALICI DAMAR OLARAK SERBEST FLEP KİMERİZASYONUNU İÇEREN FARKLI MODALİTELERLE BİRLİKTE TORAKOAKROMİAL ARTERYEL GÖVDE VE SEFALİK VEN SİSTEMİNİN KULLANIMI

Year 2021, Volume: 28 Issue: 2, 247 - 253, 15.06.2021
https://doi.org/10.17343/sdutfd.747028

Abstract

Amaç
Baş-boyun, kol ve gövdeye konforlu ve güvenilir olarak
serbest flep transferi için, bu bölgelerin ana alıcı
damarlarının önceki cerrahi, radyoterapi veya travma
sonucu elverişsiz olmaları durumunda, cerrahlara Torakoakromial
arter gövdesi ve Sefalik venin (TAT-CV)
varlığını hatırlatmayı amaçladık.
Gereç ve Yöntem
Baş-boyun veya üst ekstremitede tümör veya travmayı
içeren, bu vasküler sistemin farklı modalitelerle
kullanılarak serbest doku transferi ile tedavi edilen 8
hasta retrospektif olarak incelendi.
Bulgular
Bu vasküler sistem bütün vakalarda güvenilir olduğunu
kanıtladı. Pektoral flep ile kimerizasyonu mümkün
kıldı. Baş-boyun rekonstrüksiyonu için 6 hastada ve
2 üst ekstremite restorasyonunda kullanıldı. Anastomozların
TAT-CV bölgesine taşınması ve CV transpozisyonu,
dolaşım sorunu olan flebi kurtarmak için oldukça
hızlı ve güvenilir yöntemler olarak bulundu.
Sonuç
Birçok rekonstrüktif cerrah tarafından anatomik olarak
iyi bilinmesine rağmen, diseksiyonunun kolaylığı,
tutarlılığı, farklı çaplı dallarının sağladığı kanlanma
ve stratejik lokasyonu yeterince rağbet görmemektedir.
Ayrıca pektoralis majör flep transferi sırasında ek
doku gereksinimi olduğunda, bu vasküler sistem alıcı
olarak orada hazır bulunmaktadır.

References

  • 1. Yazar S. Selection of recipient vessels in microsurgical free tissue reconstruction of head and neck defects. Microsurgery. 2007;27(7):588-94. Review.
  • 2. Schultze-Mosgau S, Grabenbauer GG, Radespiel-Troger M, Wiltfang J, Ries J, Neukam FW, Rodel F. Vascularization in the transition area between free grafted soft tissues and pre-irradiated graft bed tissues following preoperative radiotherapy in the head and neck region. Head Neck 2002;24:42–51.
  • 3. Bernstein EF, Sullivan FJ, Mitchell JB, Salomon GD, Glatstein E. Biology of chronic radiation effect on tissues and wound healing. ClinPlastSurg 1993;20:435–453.
  • 4. Bengtson BP, Schusterman MA, Baldwin BJ, Miller MJ, Reece GP,Kroll SS, Robb GL, Goepfert H. Influence of prior radiotherapy on the development of postoperative complications and success of free tissue transfers in head and neck cancer reconstruction. Am J Surg 1993;166:326–330.
  • 5. Herle P, Shukla L, Morrison WA, Shayan R. Preoperative radiation and free flap outcomes for head and neck reconstruction: a systematic review and meta-analysis. ANZ J Surg. 2015 Mar;85(3):121-7.
  • 6. Wong KK, Higgins KM, Enepekides DJ. Microvascular reconstruction in the vessel-depleted neck. CurrOpinOtolaryngol Head Neck Surg. 2010 Aug;18(4):223-6. doi: 10.1097/MOO.0b013e32833a2e50.
  • 7. Jacobson AS, Eloy JA, Park E, Roman B, Genden EM. Vessel-depleted neck: techniques for achieving microvascular reconstruction. Head Neck. 2008 Feb;30(2):201-7.
  • 8. Saint-Cyr M, Youssef A, Bae HW, Robb GL, Chang DW. Changing trends in recipient vessel selection for microvascular autologous breast reconstruction: an analysis of 1483 consecutive cases. PlastReconstr Surg. 2007 Jun;119(7):1993-2000.
  • 9. Zhang C, Sun J, Zhu H, Xu L, Ji T, He Y, Yang W, Hu Y, Yang X, Zhang Z. Microsurgical free flap reconstructions of the head and neck region: Shanghai experience of 34 years and 4640 flaps. Int J Oral Maxillofac Surg. 2015 Jun;44(6):675-84.
  • 10. Harris JR, Lueg E, Genden E, Urken ML. The thoracoacromial/cephalic vascular system for microvascular anastomoses in the vessel-depleted neck. Arch Otolaryngol Head Neck Surg. 2002 Mar;128(3):319-23.
  • 11. Sarletti JM. Reconstruction principles and recipient vessel anatomy, selection, and exposure. In: Wei FC, Mardini S. Flaps and Reconstructive Surgery. China, Elsevier, 2009. 47 p.
  • 12. Aycock JK, Stenson KM, Gottlieb LJ. The thoracoacromial trunk: alternative recipient vessels in reoperative head and neck reconstructive microsurgery. PlastReconstr Surg. 2008 Jan;121(1):88-94. doi: 10.1097/01.prs.0000293858.11494.96.
  • 13. Onoda S, Sakuraba M, Asano T, Miyamoto S, Hayashi R, Asai M, Kimata Y. Thoracoacromial vessels as recipients for head and neck reconstruction and cause of vascular complications. Microsurgery. 2011 Nov;31(8):628-31. doi:10.1002/micr.20947.
  • 14. Doi K, Arakawa Y, Hattori Y, Baliarsing AS. Restoration of elbow flexion with functioning free muscle transfer in arthrogryposis: a report of two cases. J Bone Joint Surg Am. 2011 Sep 21;93(18):e105. doi: 10.2106/JBJS.J.01846.
  • 15. Bendon CL, Giele HP. Second toe metatarsophalangeal joint transfer for sternoclavicular joint reconstruction. J Hand Surg Am. 2014 Jul;39(7):1327-32. doi:10.1016/j.jhsa.2014.03.027.
  • 16. Kompatscher P, Manestar M, Schuster A, Lang A, Beer GM. The thoracoacromial vessels as recipient vessels in microsurgery and supermicrosurgery: an anatomical and sonographic study. PlastReconstr Surg. 2005 Jan;115(1):77-83.
  • 17. Engel H, Pelzer M, Sauerbier M, Germann G, Heitmann C. An innovative treatment concept for free flap reconstruction of complex central chest wall defects—the cephalic-thoraco-acromial (CTA) loop. Microsurgery. 2007;27(5):481-6.
  • 18. Vasilakis V, Patel HD, Chen HC. Head and neck reconstruction using cephalic vein transposition in the vessel-depleted neck. Microsurgery. 2009;29(8):598-602.
  • 19. Milliat F, François A, Isoir M, Deutsch E, Tamarat R, Tarlet G, Atfi A, Validire P, Bourhis J, Sabourin JC, Benderitter M. Influence of endothelial cells on vascular smooth muscle cells phenotype after irradiation: implication in radiation-induced vascular damages. Am J Pathol. 2006 Oct;169(4):1484-95.
  • 20. Russell NS, Hoving S, Heeneman S, Hage JJ, Woerdeman LA, de Bree R, Lohuis PJ, Smeele L, Cleutjens J, Valenkamp A, Dorresteijn LD, Dalesio O, Daemen MJ, Stewart FA. Novel insights into pathological changes in muscular arteries of radiotherapy patients. RadiotherOncol. 2009 Sep;92(3):477-83.
  • 21. Valentino J, Helton WB, Unnikrishnan R, Kudrimoti M, Arnold SM, Gal TJ. Microvascular reconstruction after intra-arterial chemotherapy with concomitant radiation. Otolaryngol Head Neck Surg. 2013 Oct;149(4):541-6.
  • 22. Ariyan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg 1979;63:73-81.
  • 23. Urken ML, Higgins KM, Lee B, Vickery C. Internal mammary artery and vein: recipient vessels for free tissue transfer to the head and neck in the vessel-depleted neck. Head Neck 2006; 28:797–801.

THE USE OF THORACOACROMIAL ARTERIAL TRUNK AND CEPHALIC VEIN SYSTEM WITH DIFFERENT MODALITIES INCLUDING CHIMERIZATION OF FREE FLAP IN DIFFICULT SITUATIONS AS THE RECIPIENT VESSELS

Year 2021, Volume: 28 Issue: 2, 247 - 253, 15.06.2021
https://doi.org/10.17343/sdutfd.747028

Abstract

Objective
We aimed to remind surgeons of the presence of the
thoracoacromial arterial trunk and cephalic vein (TATCV)
for a comfortable and reliable free flap transfer
to the head, arm, and trunk, in case the mainstream recipient vessels of these regions pose some inconveniences
due to previous surgery, radiotherapy, or
trauma.
Material and Methods
Eight cases of trauma or tumor involving the head and
neck or upper extremity, treated with free tissue transfer
in which this vascular system was used with different
modalities, were reviewed retrospectively.
Results
This vascular system proved to be reliable in all cases.
It enabled chimerization with the pectoral flap. It was
used in six patients for head and neck reconstructions
and in two upper extremity restrorations. Switching
the anastomoses to TAT-CV site and cephalic vein
transposition were found to be rapid and reliable methods
to rescue a flap with compromised circulation.
Discussion
Although anatomically well known by many reconstructive
surgeons, its ease of dissection, consistency,
supply of branches of differing caliber, and strategic
location is not adequately appreciated. Moreover, in
cases of pectoralis major flap transfer in which additional
tissue is required, this vascular system is already
there to receive it.

References

  • 1. Yazar S. Selection of recipient vessels in microsurgical free tissue reconstruction of head and neck defects. Microsurgery. 2007;27(7):588-94. Review.
  • 2. Schultze-Mosgau S, Grabenbauer GG, Radespiel-Troger M, Wiltfang J, Ries J, Neukam FW, Rodel F. Vascularization in the transition area between free grafted soft tissues and pre-irradiated graft bed tissues following preoperative radiotherapy in the head and neck region. Head Neck 2002;24:42–51.
  • 3. Bernstein EF, Sullivan FJ, Mitchell JB, Salomon GD, Glatstein E. Biology of chronic radiation effect on tissues and wound healing. ClinPlastSurg 1993;20:435–453.
  • 4. Bengtson BP, Schusterman MA, Baldwin BJ, Miller MJ, Reece GP,Kroll SS, Robb GL, Goepfert H. Influence of prior radiotherapy on the development of postoperative complications and success of free tissue transfers in head and neck cancer reconstruction. Am J Surg 1993;166:326–330.
  • 5. Herle P, Shukla L, Morrison WA, Shayan R. Preoperative radiation and free flap outcomes for head and neck reconstruction: a systematic review and meta-analysis. ANZ J Surg. 2015 Mar;85(3):121-7.
  • 6. Wong KK, Higgins KM, Enepekides DJ. Microvascular reconstruction in the vessel-depleted neck. CurrOpinOtolaryngol Head Neck Surg. 2010 Aug;18(4):223-6. doi: 10.1097/MOO.0b013e32833a2e50.
  • 7. Jacobson AS, Eloy JA, Park E, Roman B, Genden EM. Vessel-depleted neck: techniques for achieving microvascular reconstruction. Head Neck. 2008 Feb;30(2):201-7.
  • 8. Saint-Cyr M, Youssef A, Bae HW, Robb GL, Chang DW. Changing trends in recipient vessel selection for microvascular autologous breast reconstruction: an analysis of 1483 consecutive cases. PlastReconstr Surg. 2007 Jun;119(7):1993-2000.
  • 9. Zhang C, Sun J, Zhu H, Xu L, Ji T, He Y, Yang W, Hu Y, Yang X, Zhang Z. Microsurgical free flap reconstructions of the head and neck region: Shanghai experience of 34 years and 4640 flaps. Int J Oral Maxillofac Surg. 2015 Jun;44(6):675-84.
  • 10. Harris JR, Lueg E, Genden E, Urken ML. The thoracoacromial/cephalic vascular system for microvascular anastomoses in the vessel-depleted neck. Arch Otolaryngol Head Neck Surg. 2002 Mar;128(3):319-23.
  • 11. Sarletti JM. Reconstruction principles and recipient vessel anatomy, selection, and exposure. In: Wei FC, Mardini S. Flaps and Reconstructive Surgery. China, Elsevier, 2009. 47 p.
  • 12. Aycock JK, Stenson KM, Gottlieb LJ. The thoracoacromial trunk: alternative recipient vessels in reoperative head and neck reconstructive microsurgery. PlastReconstr Surg. 2008 Jan;121(1):88-94. doi: 10.1097/01.prs.0000293858.11494.96.
  • 13. Onoda S, Sakuraba M, Asano T, Miyamoto S, Hayashi R, Asai M, Kimata Y. Thoracoacromial vessels as recipients for head and neck reconstruction and cause of vascular complications. Microsurgery. 2011 Nov;31(8):628-31. doi:10.1002/micr.20947.
  • 14. Doi K, Arakawa Y, Hattori Y, Baliarsing AS. Restoration of elbow flexion with functioning free muscle transfer in arthrogryposis: a report of two cases. J Bone Joint Surg Am. 2011 Sep 21;93(18):e105. doi: 10.2106/JBJS.J.01846.
  • 15. Bendon CL, Giele HP. Second toe metatarsophalangeal joint transfer for sternoclavicular joint reconstruction. J Hand Surg Am. 2014 Jul;39(7):1327-32. doi:10.1016/j.jhsa.2014.03.027.
  • 16. Kompatscher P, Manestar M, Schuster A, Lang A, Beer GM. The thoracoacromial vessels as recipient vessels in microsurgery and supermicrosurgery: an anatomical and sonographic study. PlastReconstr Surg. 2005 Jan;115(1):77-83.
  • 17. Engel H, Pelzer M, Sauerbier M, Germann G, Heitmann C. An innovative treatment concept for free flap reconstruction of complex central chest wall defects—the cephalic-thoraco-acromial (CTA) loop. Microsurgery. 2007;27(5):481-6.
  • 18. Vasilakis V, Patel HD, Chen HC. Head and neck reconstruction using cephalic vein transposition in the vessel-depleted neck. Microsurgery. 2009;29(8):598-602.
  • 19. Milliat F, François A, Isoir M, Deutsch E, Tamarat R, Tarlet G, Atfi A, Validire P, Bourhis J, Sabourin JC, Benderitter M. Influence of endothelial cells on vascular smooth muscle cells phenotype after irradiation: implication in radiation-induced vascular damages. Am J Pathol. 2006 Oct;169(4):1484-95.
  • 20. Russell NS, Hoving S, Heeneman S, Hage JJ, Woerdeman LA, de Bree R, Lohuis PJ, Smeele L, Cleutjens J, Valenkamp A, Dorresteijn LD, Dalesio O, Daemen MJ, Stewart FA. Novel insights into pathological changes in muscular arteries of radiotherapy patients. RadiotherOncol. 2009 Sep;92(3):477-83.
  • 21. Valentino J, Helton WB, Unnikrishnan R, Kudrimoti M, Arnold SM, Gal TJ. Microvascular reconstruction after intra-arterial chemotherapy with concomitant radiation. Otolaryngol Head Neck Surg. 2013 Oct;149(4):541-6.
  • 22. Ariyan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg 1979;63:73-81.
  • 23. Urken ML, Higgins KM, Lee B, Vickery C. Internal mammary artery and vein: recipient vessels for free tissue transfer to the head and neck in the vessel-depleted neck. Head Neck 2006; 28:797–801.
There are 23 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Research Articles
Authors

Selman Hakkı Altuntaş 0000-0002-9577-7052

Fuat Uslusoy 0000-0003-0552-0139

Dudu Dilek Yavuz 0000-0001-9654-9097

Asım Aydın 0000-0003-1107-5238

Publication Date June 15, 2021
Submission Date June 3, 2020
Acceptance Date September 29, 2020
Published in Issue Year 2021 Volume: 28 Issue: 2

Cite

Vancouver Altuntaş SH, Uslusoy F, Yavuz DD, Aydın A. THE USE OF THORACOACROMIAL ARTERIAL TRUNK AND CEPHALIC VEIN SYSTEM WITH DIFFERENT MODALITIES INCLUDING CHIMERIZATION OF FREE FLAP IN DIFFICULT SITUATIONS AS THE RECIPIENT VESSELS. Med J SDU. 2021;28(2):247-53.

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