Anatomical superficial cervical artery and perforating branches using multi-detector computed tomography

Nội dung text: Anatomical superficial cervical artery and perforating branches using multi-detector computed tomography

1. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 ANATOMICAL SUPERFICIAL CERVICAL ARTERY AND PERFORATING BRANCHES USING MULTI-DETECTOR COMPUTED TOMOGRAPHY Vo Anh Minh1,2, Nguyen Gia Tien3, Vu Quang Vinh3 SUMMARY Objectives: To study the anatomy of the superficial cervical artery using multi-detector computed tomography Subjects and methods: A describe a case series of 31 patients who had performed multi-detector computed tomography and reconstructed the superficial cervical artery at the Hoa Hao Medical Diagnostic Center, Ho Chi Minh City. Patients are randomly selected. Results: We recorded the following results through the survey of 31 cases: average age 57.52 ± 14.06 years. We note that 29/31 cases have to originate from the transverse cervical artery. The average length of the superficial cervical artery is 83.02 ± 25.78 mm, and the average diameter is 2.45 mm. The distance from the position of fascial perforating branches to the horizontal spine of C7 and the occipital tail is respectively 59.91 ± 12.05 mm and 97.71 ± 30.29 mm. The average number of perforating branches is 1.40. Conclusion: Multi-detector computed tomography is useful in the investigation of the superficial cervical artery. However, it is difficult to investigate perforating branches. * Keyword: Superficial cervical artery; Transverse cervical artery; Perforating trapezius branches. INTRODUCTION [1]. Since then, Rei Ogawa and his Superficial cervical artery comes from colleagues developed it for use as a skin the transverse cervical artery, originating flap in 1990, and in 1993, they succeeded from the artery branch on the shoulder. in removing it as a free flap. Since 1986, The Superficial cervical artery passes they have performed 41 superficial cervical through the trapezius muscles to the artery flaps of all types from 32 patients to subcutaneous tissue and the skin tissue. reconstruct cervical scars [2]. Later, when Superficial cervical arteries join blood we reviewed the literature, we found that vessels around the shoulder blades. few studies used superficial cervical Because of anatomical characteristics, artery flaps. One of the main reasons is the superficial cervical artery flap was first the lack of clinical data and anatomical reported by Nakajima and Fujino in 1984 images of the superficial cervical artery, 1Vietnam Military Medical University 2Trung Vuong Hospital, Ho Chi Minh City 3Le Huu Trac National Burns Hospital Corresponding author: Vo Anh Minh (voanhminh64@gmail.com) Date received: 21/7/2021 Date accepted: 02/8/2021 200
2. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 so the use of this flap is relatively limited. - Cut the thickness of the cutting layer Previous techniques commonly used to thickness: 0.5 mm. examine arteries were angiography, in - Kv: 100, mAs: 150 - 250. Pitch 0.6 - 1,375 which they injected the contrast material - Speed of rotation 0.33 - 0.5s in veins and performed on a cadaver [3]. - FOV: Choose as small as possible. With the development of diagnostic - Contrast injection into a right arm vein imaging devices, multi-detector computed - Dose of contracted solution: ≤ 1mL/kg tomography could survey blood vessels with dimensions from 1mm. For the above Processing [6]: reasons, we carried out this research: - Step 1: Cut in two vertical and To study the anatomy of the superficial horizontal planes (coronal and axial) cervical artery using multi-detector - Step 2: Cut a thickness of 0.5 mm in computed tomography. front of the heart to locate the end of the abdominal aorta to set the density SUBJECTS AND METHODS measurement point for the Bolus timing 1. Subjects program. 31 cases who were performed the - Step 3: CT-scan after contrast injection MDCT to evaluate the superficial cervical starts artery branches on the straps until artery at the Hoa Hao Medical Diagnostic the carotid artery is common on both sides. Center, Ho Chi Minh City. The patient had * Reconstructing artery: selected randomly. Patients were carefully Using specialized software (MIP, VR) explained the procedure, purpose, and regenerates the artery in different directions, safety of this method and agreed to prioritizing to exposing the superficial participate in the study. cervical artery and the transverse branches that provide the skin flap. 2. Methods * Study design: A series of descriptive studies. * Protocol of MSCT at Hoa Hao Medical Diagnostic Center: The patient was consulted and explained the process of MDCT Fasting carefully before shooting 6 hours. In the supine position, intravenous iodine contrast is injected from the arm vein. . Set machine parameters - Using Toshiba Aquiloin One (640 MSCT) Figure 1: A superficial cervical artery - Enter the full information data of the through background angiogram patient. (yellow arrow). 201
3. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 * Investigate features of superficial - Determining the location of origin and cervical arteries and perforating branches: path of the two arteries related to other components. - Determining the origin of the superficial cervical artery. - Determining the number of transverse branches of the superficial cervical artery. - The length (mm) of the artery is Determine the number of branches, paths, calculated from the root to the position of and related. perforating fascia. - Determine the distance from the - Diameter (mm) of the superficial perforating fascia to the spinous process cervical artery. of the C7 spine and the occipital bone. Length of superficial cervical artery from Diameter of superficial cervical artery origin to position of perforating fascia The distance from the position of The distance from the position of perforating fascia to the spinous process perforating fascia to the occipital bone of C7 spine Figure 2: Characteristics of a superficial cervical artery in MDCT. * Data processing: Data was collected and analysed by SPSS 20.0. 202
4. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 RESULTS The superficial cervical artery with an average length from the origin to the From 1/2019 to 12/2019, we collected perforating fascia is 106.7 mm. The 31 cases who had performed the MDCT average diameter is 1.84 mm, the highest and reconstructed the superficial cervical is 2.2 mm, and the lowest is 1.3 mm. artery survey at Hoa Hao Medical Regarding the superficial cervical artery Diagnostic Center - Ho Chi Minh City. position, the distance from the perforating The average age of patients was 57.52 ± fascia to the spinous process of the C7 spine 14.06 years. and the occipital bone is 39.17 ± 9.95 mm Regarding the origin of the superficial and 133.97 ± 19.811, respectively. The cervical artery, we note that 29/31 cases average number of perforating branches have an origin rising from the transverse is 2.63, and the highest is 5 branches and cervical artery. There is 1 case derived at least 2 branches. In addition, we note from the thyrocervical trunk and 1 case that the average angle of the superficial originating from the cervico-dorso-scapular cervical perimeter across the scale is trunk. 144.59 ± 21.62 degrees. Table 1: Characteristics of patients. n (n = 31) Ratio (%) Sex Male 15 48.4 Female 16 51.6 Age 57.52 ± 14.06 Table 2: Anatomy of the superficial cervical artery. Mean Range The length from the root to the position of perforating fascia (mm) 83.02 ± 25.78 70.2 - 143.6 Diameter of superficial cervical artery (mm) 2.45 ± 0.41 0.6 - 2.8 The distance from the position of perforating fascia to the spinous 59.91 ± 12.05 22.0 - 85.5 process of the C7 spine (mm) The distance from the position of perforating fascia to the occipital 97.71 ± 30.29 33 - 142.2 bone (mm) Number of branches 1.40 ± 0.62 1 - 3 Angle of the superficial cervical perforating the fascia 144.59 ± 21.62 95.4 - 177.2 Diameter of superficial cervical artery at the perforating fascial 1,17 ± 0,15 0.92 - 1.29 position (mm) 203
5. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 Originating from the thyrocervical trunk Originating from the cervico-dorso-s capular trunk Figure 3: Originating of the superficial cervical artery. DISCUSSION artery skin flap showing that 23/41 cases Through an anatomical survey of had flap length > 30 cm and 31/41 cases superficial cervical arteries in 31 cases, had flap width > 10 cm, skin flap size the we found that the superficial cervical largest one is 35 x 14 cm, and the artery had on average 1.40 branches, and smallest is 12 x 6 cm. With such flap size, the average length was 83.05 mm. This the author only noted that 4/41 cases flap shows that the dorsal skin will have the necrotic at distal part. This proves that the blood supply plentiful, which is the basis superficial cervical artery flap can get for using the superficial cervical artery flap large in size and cover the high damage. in reconstructed the posterior cervical When investigating the origin of the defects. In addition, we found that the superficial cervical artery, we found that angle of the dorsal plane consistent with 29/31 cases are originating from the the superficial cervical perforating fascia transverse cervical artery; there is 1 case was 144.59 ± 21.62 degrees. This shows derived from the thyrocervical trunk and 1 that turning the skin flap from the tip of the case originating from the cervico-dorso- shoulder to the spine will reduce the lack scapular trunk. By Weiglein [5], an of vascular twisting, reducing the proportion analysis of 498 fresh cadavers showed of the skin necrosis due to unsupply blood. that the origin of superficial cervical artery We found that the average length of from the transverse cervical artery only the superficial cervical artery was 83.05 accounted for 16%. Superficial cervical mm, suggesting that the expected flap artery usually comes from the common length could be > 20 cm. Ogawa [2] body of the supraclavicular artery (20%) reported 41 cases of superficial cervical and the cervico-dorso-scapular artery (20%) 204
6. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 In 2019, another study by author variations of the arterial branches. Lateral Bulbul on the variants of the lateral neck vessels. The author noted that 68% cervical artery in 135 patients with 64- of superficial cervical artery THD slice computed tomography with vascular originates directly from the body of the contrast injection showed five types of thyroid gland in the neck [7]. Figure 4: Anatomy variants of neck artery branches in MDCT [7]. CDT: Cervicodorsal trunk; CDST: Cervicodorsoscapular trunk; CST: Cervicoscapular trunk; DScA: Ddorsal scapular artery; DST: Dorsoscapular trunk; IMA: Internal mammarian artery; SCA: Subclavian artery; SpCA: Superficial cervical artery; SSA: Suprascapular artery; ThyCT: Tyhro-cervical trunk; VA: Verte- bral artery. When we reviewed the literature, we through the muscle to the skin and in found very few reports on the anatomy of place perforating fascia, diameter is 0.7 the superficial cervical artery branch. mm or more [4] Most superficial cervical arteries are Although there are many variations in referred to an as a small branch of the the origin of the superficial cervical artery, transverse cervical artery. We note the the trans-muscular position of the diameter is on average 2.45 mm, the superficial cervical artery is relatively large diameter is 2.8 mm. Ogawa [2] constant across studies. Our study found that all the diameters of the showed the correlation of the trans- superficial cervical artery in 41 plastic muscular position of the superficial surgery were larger than 0.7 mm. Philippe cervical artery with anatomical landmarks: et al. studied the anatomical trapezius the distance from the position of the trans- muscle on 58 cadavers confirming the fascial superficial cervical artery to the C7 superficial cervical artery branched blood vertebral column and the external supply to the middle and distal region of occipital fossa was 59.91 ± 12.05 mm, the trapezius muscle, the branches respectively, and 97.71 ± 30.29 mm. 205
7. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 This helps to locate the transverse them as perforator flaps. PRSJournal.com position of the superficial cervical artery in 2006:95-101. practice during surgery. 3. H. Hyakusoku, Y. Takizawa, M. Murakami, et al. Versatility of the free or CONCLUSION pedicled superficial cervical artery skin flaps in Multi-detector computed tomography is head and neck burns. Bums 1993; 19(21):168-173. effective for examining the superficial cervical artery branch. However, this is an 4. Philippe Manyacka MA Nyemb, Christian Fontaine, et al. Morphological expensive method, so it is not widely anatomy of the trapezius muscle, about 58 available. In addition, MDCT scans dissections: What to know before harvesting cannot examine the perforating branches the muscular flap. MOJ Anat Physiol 2017; when crossing the superficial cervical 4(4):348-353. artery's fascia and the perfusion region. 5. Weiglein A.H, Moriggl B., Schalk C. et al. Arteries in the posterior cervical triangle in REFERENCES man. Clin. Anat 2005; 18:553-557. 1. Nakajima H., Kaneko T., Fujino T. Thin 6. Guidance on specialized technical extended latissimus dorsi musculocutaneous process of Image diagnosis and photoelectric flap. Presented at the 9th meeting of the interventions according to Decision international society of reconstructive No.25/QD-BYT dated January 3, 2013 of the microsurgery. Tokyo, Japan 1988, April:17-22. Ministry of Health. 2. Rei Ogawa, M. Murakami. Clinical and 7. Bulbul, E., Yanik, B., Akay, E., et al. anatomical study of surperfical cervical artery Arterial variations within the lateral cervical flaps: Retrospective study of reconstructions region: A multidetector CT angiography study. with 41 flaps and the feasibility of harvesting Int. J. Morphol 2019; 37(3):991-996. 206