CLINICAL AND MORPHOLOGICAL CHARACTERISTICS OF ANGIOSOME FLAP IN THE TEMPORAL AND PARIETAL AREA FOR REPLACING THE DEFECTS AND DEFORMITIES OF THE HEAD AND NECK
About the author:
Avetikov D. S., Kaplun D. V., Danylchenko S. I.
Type of article:
The problem of substitution of extensive defects on the head and neck remains relevant for many years. For present time it is reasonable due to the presence of a huge group of patients whose surgical treatment is a medical and social problem. Flaps from temporal and parietal regions are promising to replace the defects and deformities on the head and neck. However, for their correct lifting and mobilization, topographoanatomic data of the superficial temporal artery which varies and depend on the shape of the head should be considered. The purpose of this research was to detail the surgical anatomy of superficial temporal artery in relation to the raising and mobilization of temporo-parietal angiosome flaps and development of new methods of their raising and mobilization by using computer simulation technology. The objects of the study were 29 patients. The reconstructive plastic recovery operations with angiosome patch-es of the temporal and parietal areas were performed for them. 56 case histories of patients who experienced complications after these operations were analyzed. To investigate the hemodynamic of transplanted grafts, im-pedance plethysmography and dopplerography were used. When lifting and mobilizing temporo-parietal flaps you must remember that the temporo-parietal fascia is separated from the deep fascia who covers the temporal muscle with layer of loose connective tissue, which is most pronounced above the ear, and thinning to the periphery. Power in the region is provided by superficial temporal vascular bundle that extends from the top of the parotid salivary gland for 1. 5 cm ahead of the tragus of the ear. In 72. 5 of cases veins settle back and deeper than the artery. As a result of our topographic anatomic researches we found that individual characteristics outside the structure of the surface of the temporal artery are connected with the form of the head. In our study main type met more often (54. 7 of cases ) than the loose one (45. 3 of cases ). We found a relationship between the type of branching superficial temporal artery and the shape of the head. Main type was mostly met in the case of dolichocephaly (67. 5 ), and the loose type in the case of brachycephaly (81. 2 ). Artery diameter ranges from 1. 7 to 2. 1 mm and longevity of vascular pedicle ranges from 4. 1 to 4. 9 cm. We recom-mend taking a flap using the T -shaped access within the scalp to ear. Neurovascular bundle tissue is easily identified in the subcutaneous adipose. After that, the skin with the cellulose should be laminated by cutting the tissue in the hair follicle. In the peripheral areas of the fascia, flap dissection becomes more difficult due to its tight connection of fibrous ridges with the skin. Considering the conducted topographic anatomic researches we should remember that the temporo – parietal flap can be used as a sophisticated flap with the release of fragments of the fascia on the branches of superficial temporal artery. The mobilization of two-layer autograft made of two composed together sites of fascia, one surface of which can be closed with split skin graft beforehand is possible. The possibility of further development of alopecia in this area and the danger of damage to the superficial branch of the facial nerve should be attributed to the postoperative complications. There were 4 cases when patient had postoperative scar expansion due to the tension in the line of stitches. Considering the data of topographoanatomic research and computer modeling branches of the superficial tem-poral artery, lifting and mobilization methods of angiosome preauricular, postauricular and temporoparietal fascial flaps are well optimized in our clinic. The result of these operations is satisfactory.
angiosome, superficial temporal artery, temporoparietal flap, retroauricular flap
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 2 part 1 (107), 2014 year, 033-036 pages, index UDK 616-089.844