Transverse Cervical Artery Perforator Flap

Abstract

The main purpose of head and neck reconstructive surgery is to provide anatomic restoration of the demolited region and to provide preservation and recovery of function. The anatomical investigations conducted over the years has enabled a detailed knowledge of human body vascularization, giving the opportunity to design and harvest more and more versatile and refined flaps, with increasingly satisfactory results. Even if in the last 2 decades free flaps have been considered a reconstructive criterion standard, they still determine a great physical impact for the patient and require a certain surgical experience. In particular, perforator flaps (based on vessels that, emerging from the main deep axis, supply superficial myofascial cutaneous tissues) represent the new reconstructive frontier, of which a wide variety of types has been described. Our purpose is to illustrate the preparation and harvesting of the transverse cervical artery perforator flap and the variety of its utilization in head and neck reconstruction. From February 2005 to May 2015, 41 reconstructions were performed, and not only for oncologic reasons. Thanks to its anatomical features, reduced donor site morbidity and rapid preparation, this flap is a safe and feasible alternative to most famous free and locoregional flaps. Because our outcomes in functional and aesthetic terms were mostly satisfying, we can assert that the transverse cervical artery perforator flap has an important role in an appropriate reconstructive strategy for head, neck, and oropharyngolaryngeal region.

Trapezius Perforator Flaps Based on Superficial Cervical Artery and Dorsal Scapular Artery

“…Previous studies have shown that the length of the superficial cervical artery could reach approximately 5 cm. 1,20 The pedicle length from the takeoff of the superficial cervical artery was 7.3 ± 2.0 cm (4.7-9.7 cm) in our cadaver dissections. This was the maximal vessel length when the perforator flap was elevated.…”

“…Because the definition of a perforator flap with a muscle cuff remains controversial and conceptually overlaps with the myocutaneous flap or muscle pedicled flap, 10 articles reporting perforator flaps with a muscular cuff were discarded 2,3,6,13–19 . One study of transverse cervical artery perforator flaps was discarded because some flaps might be pedicled by the supraclavicular perforator 20 . Finally, 6 articles were considered for use in this review 21–26 …”

“…2,3,6,[13][14][15][16][17][18][19] One study of transverse cervical artery perforator flaps was discarded because some flaps might be pedicled by the supraclavicular perforator. 20 Finally, 6 articles were considered for use in this review. [21][22][23][24][25][26] A total of four true SCAP flaps were reported in 2 articles (Table 3).…”

Free Flap Reconstruction of a Challenging Defect in the Posterior Cervicothoracic Region Using the Transverse Cervical Artery

“…In our case, the use of the transverse cervical artery and internal jugular vein as recipient vessels for the ALT free flap enabled us to address above-mentioned difficulties that are reluctant to perform a free flap in this region. Because the transverse cervical artery has sufficient length and originates from the subclavian artery (56.7%) or the thyroid-cervical trunk (42.4%) and continues to the scapular area as the descending branch of the transverse cervical artery (also called the dorsal scapular artery), this artery can provide a reliable recipient artery for the microvascular free flap reconstruction of posterior cervicothoracic defects [4,8]. However, the lack of a recipient vein around defect areas remains a reluctance to perform a free flap for many surgeons.…”