A propeller superficial transverse cervical artery perforator flap for defect coverage of the submental area: a case report

Reconstruction of submental defects is a challenge that needs to be approached carefully, since many important anatomical structures are located in this small space. Both aesthetic and functional outcomes should be considered during reconstruction. In this report, we describe a case where a superficial branch of the transverse cervical artery (STCA) perforator propeller flap was applied for coverage of the submental area. An 85-year-old woman presented with a 3-cm ovoid mass on her submental area. We covered the large submental defect with a STCA rotational flap in a 180° propeller pattern. The flap survived well without any complications at 1 year of follow-up. A STCA propeller flap is a useful surgical option in reconstruction for defect coverage of the submental area.

Indocyanine Green Fluorescence Angiography of the Transverse Cervical Arterial Supply to Clavicle Flaps: An Anatomical Study

Objective To describe the anatomy of the transverse cervical artery and to prove its perfusion to the clavicle using indocyanine green fluorescence angiography as an alternative vascularized bone for head and neck reconstruction. Study Design Cadaveric dissection. Setting Anatomy lab. Methods Twenty-two necks and shoulders from 11 fresh-frozen cadavers were dissected. The transverse cervical artery diameter, length, emerging point, and the length of clavicle segment harvested were described. Photographic and near-infrared video recordings of the bone’s medial and longitudinal cut surfaces were taken prior to, during, and after indocyanine green injection. Results The transverse cervical artery originated from the thyrocervical trunk and emerged at the level of the medial one-third of the clavicle in 22 of 22 (100%) specimens. The average length of the pedicle was 3.6 cm (range, 2.2-4.4 cm), and the mean diameter was 2.5 mm (range, 1.8-3.4 mm). The harvested bone had a mean length of 5.1 cm (range, 4.3-5.8 cm). After injecting the indocyanine green, 22 of 22 (100%) specimens showed enhancement in the periosteum, bony cortex, and medulla. Conclusion The middle third of the clavicle can be reliably harvested as a vascularized bone with its perfusion solely from the transverse cervical artery pedicle, as shown by the near-infrared fluorescence imaging. The pedicle was sizable and constant in origin.

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

Reconstructions of large defects located in the posterior cervicothoracic region still present challenges to plastic surgeons. The local or regional flap is preferred in the posterior cervicothoracic region and many surgeons are reluctant to perform reconstruction using a microvascular free flap because of various reasons including vascular paucity. We report a case of a 60-year-old patient with the chronic wound at posterior cervicothoracic region. An anterolateral thigh free flap was considered the best available reconstructive method due to the size of the defect and the possibility of damaging the dorsal scapular artery. We used the transverse cervical artery and jugular vein as recipient vessels and the better result was shown than that of regional or local flaps. In our report, we presented that the transverse cervical artery which didn’t have commonly used can provide a reliable and advantageous recipient artery for the microvascular free flap reconstruction of posterior cervicothoracic defects.

Conventional and variant origin of the transverse cervical artery in a select kenyan population

Data from previous studies have highlighted on the use of transverse cervical artery (TCA) flaps as posterior neck musculocutaneous flaps in reconstructive surgeries. General preference of flap selection relies heavily on the neurovascular supply of the flap in question and even though known, the transverse cervical artery has been shown to vary among populations, therefore affecting its use as a potential flap. Additionally, variant points of origin of the trans-cervical artery have been shown to predispose to brachial plexus compression. Our data on the same, however, remains partly elucidated and therefore a study aimed at describing the conventional and variant origin of the TCA in a Kenyan population would aid in deciding on its use as musculocutaneous flaps and determining the possible prevalence of brachial plexus compression because of its variant origin. The origin of the transverse cervical artery was studied bilaterally in 26 adult Kenyan cadavers in the Department of Human Anatomy, University of Nairobi. As regards their origin, the different types were photographed and grouped into five: Types I to V relative to its origin. The data collected was then analysed using SPSS version 21 and findings presented as percentages. The findings were presented in a bar graph and pie chart. The TCA was present in all the 26 cadavers studied. Type I origin of the TCA was the most common (71.15%) while type V was the least (1.92%). While type I origin occurred mostly on the left limbs, the other types were more prevalent on the right side. The significant variant origin of the TCA and its resultant aberrant course should be important considerations during the planning of posterior neck musculocutaneous flaps as well as in understanding brachial plexus compression associated with its variant origin. Key Words: Anatomy, Transverse cervical artery.

Revisiting the Transverse Cervical Artery and Vein for Complex Head and Neck Reconstruction

Background Chemoradiotherapy is the primary treatment modality for glottic and pharyngeal subsites. Management of recurrence or second primaries in this setting is a surgical challenge requiring complex free flap reconstruction. One of the major barriers to effective reconstruction is the availability of suitable recipient vessels. We propose that the transverse cervical artery (TCA) is a viable option for complex head and neck reconstruction. Methods A retrospective chart review of 230 consecutive free tissue reconstructive cases was performed by the senior author (EG). Results Forty cases were identified that used the TCA for arterial anastomosis. Twenty-six patients had prior treatment, 13 of which had multimodality treatment. There were no microvasculature free flap failures and 5 minor flap complications. Conclusions Our experience with the TCA suggests it is a viable option for complex head and neck reconstruction, particularly in the setting of prior comprehensive neck dissection or radiation. In addition, the location of the TCA provides favorable pedicle geometry for microvascular anastomosis.