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Objective: by trauma, especially skin defects of the face and neck caused by deep burns, and the face and neck scar contracture treatment very difficult. Anatomical study, to understand entries neck and shoulder brachial blood supply of the skin, on the basis of the anatomical study design entries neck and shoulder brachial flap for the repair of the face and neck skin defect. Observe its scope of application and clinical effects, in order to provide a new method for repairing surface defects of the skin of the neck, and summarizes the indications for surgery and the advantages and disadvantages. Method: 1. Selected 12 10 ℅ preservation of formalin fixed cadaveric after thyrocervical stem intubation, perfusion latex solution, 10 cases of blood supply in the neck, shoulder, humerus skin is used to observe the items, focus on understanding its vascular origin, course, thickness and branch, and the other two cases surgical simulation design. Select appropriate cases based on anatomy, a carotid neck and shoulder brachial flap face and neck skin defect. Clinical follow-up for six months to two years, focusing on understanding the clinical effects, including subjective assessment and objective assessment. The results: 1. Applied anatomy: neck and shoulder brachial flap pedicle blood supply from branches of the anterior subclavian artery trapezius muscle pedicle blood supply. Trapezius muscle's blood supply from three sources, including: (1) self-thyroid collodiaphyseal issued carotid artery branch. ⑵ transverse cervical artery ascending branch. (3) scapular artery and thoracoacromial artery branch. Superficial cervical cutaneous branch of the transverse cervical artery transverse cervical superficial branch of the transverse cervical deep branch, thoracic artery perforator cutaneous branch of the humeral artery and thoracoacromial artery skin between the branches, has a very broad agreement to form a rich vascular network entries neck and shoulder brachial blood supply of the skin, organically linked. Transverse cervical artery liter sub-branches to the trapezius clavicle to the head attached to the Ministry, in the vicinity of the acromioclavicular joint direct cutaneous artery through the trapezius down extends to the shoulder and lateral arm. Raise nutritional items neck and shoulder brachial skin blood vessels through the deep fascia, deep fascia, subcutaneous fat and lower dermis repeatedly issued more small blood vessels branch dendritic or funnel-shaped distribution of supplies blood to the superficial tissue, distributed to the blood vessels of the lower dermis the anastomotic branch densely agreement, each fascia perforating branches of the vascular network formation in the lower dermis similar \The distal flap Enforcement perfusion. 2. Clinical applications: Clinical pedicle to the root of the neck, shoulder, upper arm anterolateral design traditional flap repair neck skin defect 15 cases, this group of patients flaps survived, follow-up of six months to two years, an average of 13 months, the flap blood supply, texture, elasticity, slightly bloated appearance. entries neck and shoulder humerus subdermal vascular network flap face and neck wounds 23 cases, flaps survived, which flaps remote about 1 cm × 2 cm necrotic wound healing after dressing after one cases of flap smaller, activity slightly restricted neck rotation. Follow-up of six months to two years, an average of 15 months, the flap blood supply, texture, elasticity, beautiful appearance, no obvious bloated. Conclusion: 1. Shoulder and neck brachial blood supply mainly from the branch of the anterior subclavian artery, trapezius muscle pedicle blood supply, the main source of blood supply trapezius transverse cervical artery. Superficial cervical cutaneous branch of the transverse cervical artery transverse cervical superficial branch of the transverse cervical deep branch of the thoracic artery perforator humeral between arterial skin support and thoracoacromial, of arterial cutaneous branch, has a very wide anastomosis form a rich vascular network entry neck and shoulder brachial blood supply of the skin, organically linked. Nutritional entries neck and shoulder brachial blood vessels of the skin in the lower dermis repeatedly issued small blood vessels branch, superficial tissue supply blood to the the dendritic or funnel-shaped distribution, distribution consistent vascular anastomotic branch to the lower dermis dense, forming \The vascular transport \3. Bilateral or unilateral entry neck and shoulder brachial flap graft for repair of full-thickness skin graft donor site is an effective means of surgical treatment of the face and neck wounds. Entries neck and shoulder brachial subdermal vascular network flap face and neck skin defect layer to obtain its blood supply can be dense consistent subdermal vascular network, but also through the subdermal vascular network exposed and subject area early establishment of the blood supply system having two sets of the vascular system, flap ischemic period, blood volume, the flap survival rate is high, the prognosis flap is not bloated, beautiful appearance, more aesthetic value.
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