Anatomic Basis Of Humeral Neck Flap And Its Clinical Application

Objective: by the trauma, in particular, the treatment of deep burn caused by skin defects in face and neck, and face -neck scar contracture deformity is difficult. Through anatomical studies to brachial blood supply of the skin of the neck and shoulder of humem, in the anatomical basis of the study design of neck and shoulder brachial flap for the repair of facial and neck skin defect. Observing its scope of application and clinical effect, in order to provide a new method of repairing the facial and neck skin defects of and summarize the indications and the advantages and disadvantages of surgery.Method: 1. Selecting 10 formalin fixed specimens that through 10℅ corrosion , after thyroid stem intubation or subclavian artery ligation, and brachial artery infusion latex solution, to observe the blood supply of the brachial focus on understanding of its vascular origin, course, and branches of thickness of the skin of the neck and shlouder.2. On the basis of anatomy, selecting the appropriate cases, using the neck and shoulder brachial flap to repair the defects of the face and neck skin. A fter clinical follow-up for six months to two years, focusing on understanding the clinical results, including the subjective assessment and objective assessment.Results: 1. Applied anatomy: brachial blood supply of neck and shoulder mainly comes from the Ministry of anterior branch of the subclavian artery, trapezius provide the blood- supply of the pedicle. Trapezius muscle blood supply has three sources, including:⑴comes from thyroid neck-shaft issued by the branch of internal carotid artery.⑵ascending branch of transverse cervical artery.⑶suprascapular artery and thoracic acromial artery branch. l branch of transverse cervical artery to the cephalic, to the trapezius muscle, attached to the Ministry of clavicle, acromioclavicular joint in the vicinity of Direct skin arteries, through the trapezius muscle, shoulder and upper arm lateral air extending downward. humeral neck to support nutrition, skin blood vessels through the deep fascia after the deep fascia, the subcutaneous fat, the lower dermis issued a number of river more small blood vessels branch to branch-or funnel-shaped distribution of blood supply to the shallow organization , distributed to the lower dermis dense vascular anastomosis anastomosis, each fascia perforating branches in the dermis underlying the formation of vascular network similar to the sizes of the , "angioma", "angioma" and "angioma" of the vessel traffic is not interrupted, the blood from the pedicle to the flap of the remote implementation of perfusion.2. Clinical Applications: clinical supraclavicular area of the neck flap pedicle, in the shoulder, upper arm design of the traditional flap anterolateral neck skin defects in 15 cases, cases of skin flap in this group all survived, follow-up six months to a 2 years, an average of 13 months, flap blood supply﹑ texture, good elasticity, shape slightly bloated. to neck humerus subdermal vascular network skin flap in face and neck wounds in 23 cases, flaps all survived, of which 1 case distal necrosis of about 1 cm×cm, after wounds healed after dressing, and 1 flap were cut due to their small size, neck rotation activity is slightly restricted. follow-up six months to two years, an average of 15 months, flap blood Yun﹑elastic texture, good, beautiful shape, no obvious fat.Conclusion: 1. Humerus neck blood supply mainly from the anterior branch of the subclavian artery, trapezius provide its pedicle blood supply. Trapezius muscle blood supply is mainly transverse cervical artery.2. Nutrition brachial neck skin blood vessels in the dermis underlying issue more small blood vessels repeatedly branch to branch-or funnel-shaped distribution of blood supply to the shallow organization, distributed to the lower dermis dense vascular anastomosis in line to form a " spider angioma, "" angioma "and" angioma "of the vessel traffic is not interrupted, the blood from the pedicle to the flap of the remote implementation of perfusion.3. Bilateral or unilateral neck brachial flap at the same time with full-thickness skin graft donor site wound repair is the face neck Wound of an effective surgical treatment. The use of subdermal vascular network humeral neck flap to repair facial and neck skin defects, its blood supply can be consistent dense layer of subdermal vascular network access, but also through the exposed subdermal vascular network and by the area early to establish the blood supply system vascular system with two sets of flaps without ischemia, blood flow to large flap high survival rate, after the flap is not more bloated, beautiful shape, more aesthetic values.