The external jugular vein anastomosis under the sternocleidomastoid muscle technique for head and neck reconstruction
The external jugular vein anastomosis under the sternocleidomastoid muscle technique for head and neck reconstruction
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胸锁乳突肌技术下颈外静脉吻合头颈重建术
DOI：
10.1097/prs.0000000000005238
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发表时间：
2018
影响因子：
3.6
通讯作者：
Iida Takuya
中科院分区：
文献类型：
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作者：
Karakawa Ryo;Harima Mitsunobu;Iida Takuya
Zhu等人的“游离皮瓣重建中的机械与手缝静脉吻合：系统综述和荟萃分析”1他们发现机械吻合耦合装置有助于缩短手术时间，降低手术再探查的可能性，并减轻皮瓣丢失。如他们的文章所述，耦合器的优点之一是通过外环对吻合部位进行可靠的支架植入。相比之下，手工缝合静脉吻合的问题之一是吻合部位不能耐受外部压力。在应用游离组织移植修复头颈部复杂外科缺损时，选择合适的受体静脉至关重要。虽然颈内静脉往往被选择，因为它提供了几个优点，2，3颈外静脉也适合作为受体静脉。最近的一项研究，其中包括一个系统的审查，显示没有显着差异之间的血栓形成率的颈内静脉和颈外静脉。4，5一些研究报告称，最好使用两个不同的静脉系统（如颈内静脉系统和颈外静脉系统）进行多次静脉置换术6;然而，使用颈外静脉作为受体静脉存在一些缺点。首先，它很容易受到外部压力的影响。第二，由于颈外静脉远离受体动脉，因此难以将供体静脉移至颈外静脉。为了应对这些挑战，我们采用胸锁乳突肌技术下的颈外静脉吻合术。一位66岁男性，舌肿块，被诊断为T3 N2 bM 0鳞状细胞癌，接受左半舌切除术和左功能性颈淋巴结清扫术。计划使用带有两条吻合静脉的股深动脉穿支皮瓣进行重建（图1）。由于保留了左侧颈外静脉，因此在胸锁乳突肌技术下进行颈外静脉吻合。从胸锁乳突肌外侧的远端到近端解剖颈外静脉。解剖时要小心，以避免损伤颈横神经，它位于颈外静脉和胸锁乳突肌之间。然后将颈外静脉从胸锁乳突肌和颈内静脉下方穿过。最后，以端对端的方式将颈外静脉与供体静脉缝合（图2）。胸锁乳突肌技术下的颈外静脉吻合有两个主要优点。首先，使用这种技术，闭合的静脉位于颈部的内部，这使得它能够承受外部压力。二是
“Mechanical versus Hand-Sewn Venous Anastomoses in Free Flap Reconstruction: A Systematic Review and Meta-Analysis” by Zhu et al. 1 They revealed that the mechanical anastomotic coupling device contributed to reduced operative time, decreased the probability of surgical reexploration, and mitigated flap loss. As mentioned in their article, one of the virtues of the coupler is reliable stenting for the anastomotic site by external rings. In contrast, one of the problems of hand-sewn venous anastomoses is that anastomotic sites are not tolerant of external pressure. In the setting of free tissue transfer for the reconstruction of complex head and neck surgical defects, the selection of suitable recipient veins is crucial. Although the internal jugular vein tends to be selected because it offers several advantages, 2, 3 the external jugular vein is also suitable as a recipient vein. A recent study, which included a systematic review, showed no significant difference in the rate of thrombosis between the internal and external jugular veins. 4, 5 Some studies have reported that it is better to perform multiple vein anastomoses with two different venous systems, such as the internal and external jugular systems6; however, the use of the external jugular vein as a recipient vein is associated with several disadvantages. First, it is easily damaged by external pressure. Second, because the external jugular vein is distant from the recipient artery, it is difficult to move the donor vein to the external jugular vein. To address these challenges, we used the external jugular vein anastomosis under the sternocleidomastoid muscle technique. A 66-year-old man with a tongue mass was diagnosed with T3N2bM0 squamous cell carcinoma and underwent left hemiglossectomy and left functional neck dissection. Reconstruction with a profunda femoris artery perforator flap with two anastomosed veins was planned (Fig. 1). Because the left external jugular vein was preserved, the external jugular vein anastomosis under the sternocleidomastoid muscle technique was performed. The external jugular vein was dissected distally to proximally to the lateral side of the sternocleidomastoid muscle. The dissection was performed carefully to avoid damaging the transverse cervical nerve, which goes between the external jugular vein and the sternocleidomastoid muscle. The external jugular vein was then passed under the sternocleidomastoid muscle and the internal jugular vein. Finally, the external jugular vein was anastomosed to the donor vein in an end-to-end manner (Fig. 2). The external jugular vein anastomosis under the sternocleidomastoid muscle technique has two main advantages. First, using this technique, the anastomosed vein is located on the interior of the neck, which allows it to tolerate external pressure. Second, the