Carotid artery protection by means of a trapezius muscle flap

Jaques, Darrell A.; Hovey, Leslie M.; Chambers, Robert G.

doi:10.1016/0002-9610(71)90438-7

Cited by 11 publications

(2 citation statements)

References 9 publications

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“…Not infrequently, these tumors also require manubrial resection and mediastinal tracheostomy [1][2][3][4][5][6][7]. When neck dissections are associated with PLE&GT, carotid and innominate arteries are at higher risk of rupture, especially if the patients have had previous radiotherapy [2,3,6].…”

Section: Introductionmentioning

confidence: 99%

“…These methods include regional trapezius muscles [7], levator scapula muscle [8], pectoralis major muscle [9], regional *Correspondence to: Antonio S. Martins, MD, Rua Roxo Moreira, No.skin flaps [10], deltopectoral flap [11], and even free fascia grafts [12] or dermis graft [13]. From the above mentioned methods of vessel protection, only the pectoralis major muscle flap (or the latissumus dorsi flap) provide enough tissue area to protect both carotid and innominate arteries in PLE&GT.…”

Section: Introductionmentioning

confidence: 99%

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Use of omentum pedicled graft to protect great vessels in gastric transposition for pharyngoesophageal cancer

et al. 1999

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Use of omentum pedicled graft to protect great vessels in gastric transposition for pharyngoesophageal cancer

et al. 1999

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Greater Omentum Used for Carotid Cover After Pharyngolaryngoesophagectomy and Gastric 'Pull-up' or Colonic 'Swing'

Freeman¹,

Brøndbo²,

Osborne³

et al. 1982

Archives of Otolaryngology - Head and Neck Surgery

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\s=b\An excellent method of rehabilitation for swallowing after total pharyngolaryngoesophagectomy is the reconstruction of the pharyngoesophagus with an autogenous visceral transplant. The most popular and reliable methods are the gastric "pull-up" and colonic "swing." A complication of this procedure\p=m-\which can result in morbidity as well as mortality\p=m-\is carotid artery rupture, especially when a neck dissection is performed. This is usually the result of wound breakdown secondary to adjunctive use of radiotherapy. When we have performed a radical neck dissection in conjunction with a visceral transplantation, we have used pedicled omentum as a live, durable cover for the carotid artery. (Arch Otolaryngol 1982;108:685-687) An excellent method for the rehabil--l\-itation of swallowing after total pharyngolaryngoesophagectomy is the reconstruction of the pharyngoesophagus with an autogenous viscer¬ al transplant.15Often with total pharyngolaryngoesophagectomy for metastatic dis¬ ease, a unilateral or bilateral neck dissection is required if a cure rather than a palliation is sought. When neck dissection is performed as a composite procedure in conjunction with resec¬ tion of the primary disease, the carot¬ id artery is at risk of rupture if wound breakdown ensues.6-7 The chance of breakdown is increased with preoper¬ ative radiotherapy and surgery for salvage.810 Surgeons have protected the carotid artery by using various regional mus¬ cle (eg trapezius muscles," strap mus¬ cles,12 and levator muscles of the scap¬ ula,1213) regional skin pedicles,14 re¬ gional fasciai flaps,15 and free grafts of fascia16 and dermis.17 The most widely used method is autogenous dermis grafting, as the dermis is easy to obtain, and the grafting causes little deformity in the patient. The harvesting process adds little to the operating time. Several authors1820 have reported a decrease in the inci¬ dence of carotid artery rupture when dermis is used in this way. Others21 report that the implanted dermis, when exposed after wound break¬ down, affords a source of, and tem¬ plate for, regenerating epithelium to cover the exposed area again. In 1970, Goldsmith and Beattie22 successfully used a pedicle of the greater omentum, tunneled subcutaneously over the sternum, to cover the carotid artery after performing a composite resection for an oral malig¬ nant neoplasm. However, this neces¬ sitated a laparotomy as a separate operation to obtain the omentum.Since in gastric "pull-up" or colonie "swing" a laparotomy must already be performed, good use can then be made of the readily available greater omentum for carotid artery protec¬ tion. The advantages to this procedure are many. The omentum is a viable structure with its own blood supply; it can be quickly moved great distances on its vascular pedicle; it is readily available at laparotomy; it provides bulk in the neck for a cosmetically pleasing postoperative appearance; it is excellent tissue for protecting the carotid artery with a thick, durable, and live cover; and if wou...

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