Anatomic Study And Clinical Application Of The Model Of Venous Drainage Of Frontal And Temporal Region

Background:the superficial temporal vascular pedicles of forehead flap used in head and neck tissue defect repair, because of its constant arterial vascular anatomy, flap for characteristics of rich, hidden, is one of the most commonly used plastic surgery flap. Because of the superficial temporal vein and artery branch relationship is not exact, clinical often happens on the distal end of the flap vein circumfluence not free, partial necrosis of the situation, to a certain extent limits the use of skin flap in clinic. On the other hand, because of the difficulty of venous drainage than arterial blood supply, research means and methods of existing has certain limitations, to a certain extent limits the further study. In order to improve to the superficial temporal vessels forehead flap type pedicle, avoid postoperative venous drainage disorder, it is necessary to further detailed study of local venous frontotemporal drainage characteristics and summarize the rules.First part of the study used 12 human cadaveric specimens, anti-corrosion and vascular of existing head facial specimens perfusing method should be improved, and the method of grouping and controlled than three specimen preparation and blood vessel in different latex perfusion method, screening method for sample preparation is the most suitable for this research project.The second part studies using 18 human cadaver heads, with dynamic anatomy of the veins of the superficial temporal artery within the catchment of frontotemporal skin, observation of artery and vein branch within the organization branches rules, summarize this region venous reflux mode. The branch of superficial temporal artery is closely associated with small venous mural for the diameter measurement was studied and the classification, proposed and branches attached to the wall of vein import protection measures point, based on the application of venous reflux mode analysis and design of several flap on the clinical common, in the light of the causes of flap occurred venous reflux disorder put forward the improvement principle of flap design. The third part study collected clinical head and facial DSA and CTA image data, carried on the analysis to the superficial temporal artery within the catchment of frontotemporal skin arteriovenous vascular image in detail, observation of artery and vein branch within the organization branches rules, venous drainage mode which obtains to verify the anatomy study. The study found that the imaging anatomic study support specimens obtained skin frontotemporal venous drainage mode, CTA examination may be more suitable as a superficial temporal flap preoperative imaging auxiliary examination.The fourth part of study according to the anatomical study and clinical results of distal anastomosis, proposed operation scheme venous vascular bundle to improve flap venous drainage disorder. Research and design of the two groups of a total of 15 patients with case-control study, vascular anastomosis group has achieved a good result all survived, and the control group appeared different degree of distal venous congestion and necrosis of the flap. Distal venous return results confirmed that under the skin of frontotemporal venous return characteristics of the proposed improved design can improve the flap of skin flap.Conclusion:venous skin frontotemporal has obvious characteristics of the regional partition, the venous return of communicating with each other in different layers from shallow to deep venous network. Flap design clinical need to consider the characteristics of the regional venous drainage and improvement, can foster strengths and circumvent weaknesses to maximize efficiency with superficial temporal vascular pedicled forehead flap.