Trapezius Osteomusculocutaneous Island Flap for Reconstruction of The Anterior Floor of The Mouth and Mandible



Trapezius Osteomusculocutaneous Island Flap for Reconstruction of The Anterior Floor of The Mouth and Mandible


W. R. PANJE



The trapezius osteomusculocutaneous island flap can be successfully used in the reconstruction of the anterior floor of the mouth and the mandibular arch (1, 2).




ANATOMY

Multiple arteries supply the trapezius muscle, but the major blood supply is provided by the transverse cervical artery arising from the thyrocervical trunk (3). The transverse cervical artery begins deep to the sternal head of the sternocleidomastoid muscle, crosses the posterior triangle, and enters the trapezius muscle on its deep surface about 4 cm medial to the acromion. The artery is identified easily as it passes deep to the posterior belly of the omohyoid muscle (Fig. 195.1).

The transverse cervical vein usually travels in the same fascial plane as the artery; however, the vein can travel superficial to the omohyoid muscle. If it is seen in this area, it should be preserved. It usually empties into the subclavian vein 2 to 3 cm lateral to where the thyrocervical trunk originates from the subclavian artery. The vein is usually the limiting factor in extending the arc of rotation of this flap.

The accessory nerve generally enters the trapezius muscle in the area of the vascular pedicle. Because of its multiple innervations of the muscle, the nerve usually can be preserved if properly dissected.

To use the scapular spine as part of this compound flap, the trapezius muscle attachment to the scapular spine must be preserved. Accessory nutrient arteries penetrate the scapular spine at the fascial attachment of the trapezius muscle to the spine (4).

Only gold members can continue reading. Log In or Register to continue

Jun 26, 2016 | Posted by in General Surgery | Comments Off on Trapezius Osteomusculocutaneous Island Flap for Reconstruction of The Anterior Floor of The Mouth and Mandible
Premium Wordpress Themes by UFO Themes