Thyrocervical trunk

Abstract: We describe a case of an aortic arch with five primary branches arising in a sequence that has previously never been reported. From right to left, the brachiocephalic trunk and left common carotid, left vertebral, and subclavian arteries originated from the convexity of the aortic arch. The last branch was the right vertebral artery that arose from the dorsal aspect of the aortic arch opposite the ligamentum arteriosum. Presenting a dilatation at its commencement, the right vertebral ran to the right behind the esophagus and entered the foramen transversarium of the seventh cervical vertebra, whereas the left vertebral passed to the foramen transversarium of the fifth cervical vertebra. The left vertebral artery gave off the left thyroid artery; a thyrocervical trunk was absent on the left side. A thyroidea ima arose from the brachiocephalic trunk. The embryology of this complex anomaly as well as its potential clinical significance are discussed.

Abstract: The sternocleidomastoid muscle has three blood supplies: the occipital artery superiorly, the superior thyroid in the middle, and the thyrocervical trunk inferiorly. A compound flap has been developed to transport segments of neck skin on either end of a pedicle of sternocleidomastoid muscle to reconstruct defects in the oral cavity or orophaynx. It permits one-stage reconstruction at the time of the primary resection and eliminates the need for skin grafts to the donor sites.

Abstract: The trapezius osteomyocutaneous island flap has evolved in postablative head and neck reconstruction as a versatile and hardy local flap which can provide intraoral lining, well-vascularized bone, and muscle bulk for the reconstruction of a complex defect. This investigative study examines the anatomy of 20 osteomyocutaneous flaps in 10 fresh cadavers and in 8 clinical patients. In our series, 80 percent (type I) of the major vascular pedicle arose from the thyrocervical trunk. In 20 percent (type II), the major pedicle arose separately from the subclavian artery. The regions perfused by the vascular trunk were further examined with microopaque and Prussian blue injections through the transverse cervical artery. Consistent areas of cutaneous staining as well as bony staining were noted over the shoulder, arm, and back and into the scapula itself. Experience with eight clinical applications of this osteomyocutaneous flap resulted in successful healing with an excellent aesthetic and functional result. Long-term follow-up was maintained on the patients for up to 36 months. Panorex radiographs and biopsies of the grafted bone were obtained on several patients. These disclosed evidence of bony remodeling and viable bone tissue. Tetracycline labeling also revealed evidence of active bony turnover.