Chapter 22 - Famona Site

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A. SCM flap reconstruction of:1. Tongue.2. Floor of mouth.3. Tonsillar fossa.4. Esophageal patency.1. Limited range and size.Indications for UsageDrawbacks2. Variable covering ability secondary to loss of either superior or inferior bloodsupply.3. Debate exists as to safety of this flap in conservation neck surgery. However, if thefascia is not violated by tumor, and nodes are "self-contained", the muscle may be used.4. Partial epithelial loss over skin paddle is common (50%0.TrapeziusAnatomyThis muscle has a broad base of origin. Fibers originate from the medial third of thesuperior nuchal line of the occipital bone, the external occipital protuberance, and theligamentum nuchae. Further, fibers originate from the seventh cervical vertebrae and thespinous and supraspinous ligaments of all the thoracic vertebrae. The muscle fans far out toinsert in essentially three bundles. The upper portion directs to the lateral third of the clavicle.The middle third fibers are directed to the acromion process horizontally, and the inferiorfibers are directed upward and laterally to insert on the medial end of the spine of the scapula.1. Ascending cervical artery.2. Transverse cervical artery.3. Suprascapular artery.Arterial Supply12
Nerve Supply1. Spinal accessory nerve.2. Third and fourth cervical nerve: sensory.Trapezius ActionThe various muscle bundles act in a coordinated effort. Subdivided, the upper fiberselevate the scapula, the middle fibers pull the scapula medially, and the lower fibers pull themedial border of the scapula downward. These efforts assist the serratus anterior muscle inthe elevation of the arm.Operative Technique1. Positioning is very important. Place the ipsilateral arm across the chest with the sideof the chest elevated.2. Measure the defect carefully. Too much flap is rarely a problem.3. The distance from the thyrocervical trunk to the defect will indicate the lengthavailable.4. Skin and subcutaneous tissue are incised and trapezius muscle with fascia (includingtransverse cervical vessels) are elevated. NB: Full thickness of muscle must be elevated sincethe blood supply enters from the deep surface.5. Blunt dissection will separate muscle bundles. NB: The venous drainage issuperficial and should be well identified and preserved before arterial dissection. The vein(TCV) is found superficial to the omohyoid, while the artery is deep to it.6. The donor site is undermined and the flap is swung forward. At this point thevascular pedicle to the thyrocervical trunk is the sole point of attachment. HANDLE WITHCARE!7. The muscle and skin are sutured into place in the defect.8. The donor site is usually closed primarily.Reconstruction of:1. Tongue.2. Floor of the mouth.3. Lateral pharynx.Indications for Usage13
Page 1 and 2: K. J. Lee: Essential Otolaryngology
Page 3 and 4: Vascularization and graft take depe
Page 5 and 6: 6. Can be used on a host bed of que
Page 7 and 8: Transposed, Advancement, and Interp
Page 9 and 10: D. Bed:1. To have well-nourished re
Page 11: Arterial Supply1. Occipital artery.
Page 15 and 16: Operative Technique1. The paddle is
Page 17 and 18: 3. Initial incision is begun in the
Page 19 and 20: evaluated for subsequent removal at
Page 21 and 22: orbital fat, the skin muscle flap i
Page 23 and 24: FaceliftPreoperative EvaluationA. T
Page 25 and 26: nerve.b. Below the zygomatic arch,
Page 27 and 28: 2. The diagnosis of hematoma is bas
Page 29 and 30: a. Relaxed skin tension lines are s
Page 31 and 32: c. Because of the marked irregulari

Chapter 22 - Famona Site

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