肩胛骨下系统自由皮瓣对于颌面部重建非常有用,因为它有助于仅使用一条肩胛骨下动脉(SSA)同时采集多个皮瓣。然而,已经报道了SSA中的畸变病例。因此,SSA的形态需要在采集皮瓣前进行术前确认。成像的最新进展,例如三维(3D)计算机断层扫描血管造影(3DCTA),便于获得高质量的血管图像。因此,我们检查了3DCTA在收获肩胛骨下系统自由皮瓣之前导航SSA过程中的实用性。我们使用3DCTA数据的39面和日本尸体的22面检查了SSA的形态和像差。SSA可以分为类型S,I,P,和A。S型SSA明显长(平均长度=44.8mm)。I型和P型SSA的平均长度较短,在大约50%的病例中测量≤2厘米。在A型中,SSA不存在。类型S的频率,I,P,SSA为28.2%,7.7%,51.3%,12.8%,分别。S型可以有利于在肩胛骨下系统自由皮瓣中收获SSA,因为它明显更长。相比之下,类型I和P可能是危险的,因为它们的平均长度较短。在A型中,由于缺乏SSA,因此不需要小心伤害腋窝动脉。当外科医生需要收获SSA时,建议术前3DCTA。
A subscapular system free-flap is extremely useful for maxillofacial reconstruction since it facilitates the simultaneous harvesting of multiple flaps using one subscapular artery (SSA) alone. However, cases of aberrations in the SSAs have been reported. Therefore, the morphology of SSA needs to be confirmed preoperatively before harvesting the flaps. Recent developments in imaging, such as three-dimensional (3D) computed tomography angiography (3D CTA), facilitate obtain high-quality images of blood vessel images. Therefore, we examined the utility of 3D CTA in navigating the course of the SSA before harvesting subscapular system free-flaps. We examined the morphology and aberrations of the SSA using 39 sides of the 3D CTA data and 22 sides of Japanese cadavers. SSAs can be classified into types S, I, P, and A. Type S SSAs are significantly long (mean length = 44.8 mm). Types I and P SSAs have short mean lengths, measuring ≤2 cm in approximately 50% of cases. In type A, the SSA is absent. The frequency of types S, I, P, and A SSAs were 28.2%, 7.7%, 51.3%, and 12.8%, respectively. Type S can be advantageous for harvesting the SSA in subscapular system free-flaps, because it is significantly longer. In contrast, types I and P might be dangerous because their mean lengths are shorter. In type A, caution is needed not to injure the axillary artery because the SSA is absent. When surgeons need to harvest the SSA, presurgical 3D CTA is recommended.