ZOR DURUMLARDA ALICI DAMAR OLARAK SERBEST FLEP KİMERİZASYONUNU İÇEREN FARKLI MODALİTELERLE BİRLİKTE TORAKOAKROMİAL ARTERYEL GÖVDE VE SEFALİK VEN SİSTEMİNİN KULLANIMI

Öz

Amaç Baş-boyun, kol ve gövdeye konforlu ve güvenilir olarak serbest flep transferi için, bu bölgelerin ana alıcı damarlarının önceki cerrahi, radyoterapi veya travma sonucu elverişsiz olmaları durumunda, cerrahlara Torakoakromial arter gövdesi ve Sefalik venin (TAT-CV) varlığını hatırlatmayı amaçladık. Gereç ve Yöntem Baş-boyun veya üst ekstremitede tümör veya travmayı içeren, bu vasküler sistemin farklı modalitelerle kullanılarak serbest doku transferi ile tedavi edilen 8 hasta retrospektif olarak incelendi. Bulgular Bu vasküler sistem bütün vakalarda güvenilir olduğunu kanıtladı. Pektoral flep ile kimerizasyonu mümkün kıldı. Baş-boyun rekonstrüksiyonu için 6 hastada ve 2 üst ekstremite restorasyonunda kullanıldı. Anastomozların TAT-CV bölgesine taşınması ve CV transpozisyonu, dolaşım sorunu olan flebi kurtarmak için oldukça hızlı ve güvenilir yöntemler olarak bulundu. Sonuç Birçok rekonstrüktif cerrah tarafından anatomik olarak iyi bilinmesine rağmen, diseksiyonunun kolaylığı, tutarlılığı, farklı çaplı dallarının sağladığı kanlanma ve stratejik lokasyonu yeterince rağbet görmemektedir. Ayrıca pektoralis majör flep transferi sırasında ek doku gereksinimi olduğunda, bu vasküler sistem alıcı olarak orada hazır bulunmaktadır.

Anahtar Kelimeler

• Sefalik ven
• Serbest flep
• Torakoakromial arter

THE USE OF THORACOACROMIAL ARTERIAL TRUNK AND CEPHALIC VEIN SYSTEM WITH DIFFERENT MODALITIES INCLUDING CHIMERIZATION OF FREE FLAP IN DIFFICULT SITUATIONS AS THE RECIPIENT VESSELS

Öz

Objective We aimed to remind surgeons of the presence of the thoracoacromial arterial trunk and cephalic vein (TATCV) for a comfortable and reliable free flap transfer to the head, arm, and trunk, in case the mainstream recipient vessels of these regions pose some inconveniences due to previous surgery, radiotherapy, or trauma. Material and Methods Eight cases of trauma or tumor involving the head and neck or upper extremity, treated with free tissue transfer in which this vascular system was used with different modalities, were reviewed retrospectively. Results This vascular system proved to be reliable in all cases. It enabled chimerization with the pectoral flap. It was used in six patients for head and neck reconstructions and in two upper extremity restrorations. Switching the anastomoses to TAT-CV site and cephalic vein transposition were found to be rapid and reliable methods to rescue a flap with compromised circulation. Discussion Although anatomically well known by many reconstructive surgeons, its ease of dissection, consistency, supply of branches of differing caliber, and strategic location is not adequately appreciated. Moreover, in cases of pectoralis major flap transfer in which additional tissue is required, this vascular system is already there to receive it.

Anahtar Kelimeler

• Cephalic vein
• Free flap
• Thoracoacromial artery

Kaynakça

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