Original Article
Anatomical basis of clavicular cross-area perforator flaps
Abstract
Background: Systematic studies of cutaneous (perforating) branches around the clavicle and their anastomosis have not yet been reported. We sought to comprehensively analyze the cutaneous (perforator) flaps surrounding the clavicle and their anastomosis to obtain the anatomical evidence for the application of cross-area perforator flaps.
Methods: A total of 20 fresh cadaver specimens were perfused with modified lead oxide-gelatin injection for angiography. The spiral CT scan data were input in two-dimensional DICOM format into an interactive medical imaging control system, Mimics Workstation. The upper chest and neck-shoulder images were captured using a crop project, followed by three-dimensional (3D) continuous reconstruction using fast direct volume rendering (VR). Then, “3D Mask”, “Edit Mask”, and other tools were used to visualize the perforators and anatomized vessels.
Results: After 3D reconstruction, the cutaneous (perforating) branches around the clavicle, anatomized vessels among perforators, and subcutaneous vessel network were clearly displayed. Three kinds of vascular anastomoses were revealed: (I) anastomosis of acromion branches of transverse cervical artery and ascending branches of posterior circumflex humeral artery; (II) anastomosis of clavicular branches of transverse cervical artery and perforating branches of thoracoacromial artery; (III) anastomosis of sternocleidomastoid myocutaneous perforators and ascending branches of 1 and 2 intercostal arteries. The average diameter of the posterior humeral circumflex artery perforator, the thoracoacromial artery perforator, the first and two intercostal arteries perforator, and the transverse cervical artery was 0.8, 0.6, 0.7, and 0.7 mm, respectively.
Conclusions: (I) Mimics can be used to conveniently and comprehensively analyze the cutaneous (perforating) branches and their vascular anastomosis. (II) Cross-area flaps can be procured according to the three types of anastomosis around the clavicle, which can be easily applied in the repair and reconstruction of maxillofacial and anterior cervical soft tissue defects. (III) In anterograde flap transposition, the key anatomical site of the vascular pedicle is located in the superior part of the acromioclavicular joint, and the vascular pedicle rotation point can be set in the occipital triangle.
Methods: A total of 20 fresh cadaver specimens were perfused with modified lead oxide-gelatin injection for angiography. The spiral CT scan data were input in two-dimensional DICOM format into an interactive medical imaging control system, Mimics Workstation. The upper chest and neck-shoulder images were captured using a crop project, followed by three-dimensional (3D) continuous reconstruction using fast direct volume rendering (VR). Then, “3D Mask”, “Edit Mask”, and other tools were used to visualize the perforators and anatomized vessels.
Results: After 3D reconstruction, the cutaneous (perforating) branches around the clavicle, anatomized vessels among perforators, and subcutaneous vessel network were clearly displayed. Three kinds of vascular anastomoses were revealed: (I) anastomosis of acromion branches of transverse cervical artery and ascending branches of posterior circumflex humeral artery; (II) anastomosis of clavicular branches of transverse cervical artery and perforating branches of thoracoacromial artery; (III) anastomosis of sternocleidomastoid myocutaneous perforators and ascending branches of 1 and 2 intercostal arteries. The average diameter of the posterior humeral circumflex artery perforator, the thoracoacromial artery perforator, the first and two intercostal arteries perforator, and the transverse cervical artery was 0.8, 0.6, 0.7, and 0.7 mm, respectively.
Conclusions: (I) Mimics can be used to conveniently and comprehensively analyze the cutaneous (perforating) branches and their vascular anastomosis. (II) Cross-area flaps can be procured according to the three types of anastomosis around the clavicle, which can be easily applied in the repair and reconstruction of maxillofacial and anterior cervical soft tissue defects. (III) In anterograde flap transposition, the key anatomical site of the vascular pedicle is located in the superior part of the acromioclavicular joint, and the vascular pedicle rotation point can be set in the occipital triangle.
