Transverse cervical artery anterior perforator flap: Systematization and applications in head and neck reconstructive surgery.

Abstract

The main objective of this study was to confirm the consistency of the transverse cervical artery anterior perforator (TCAP) and describe its anatomical landmarks. The secondary objective was to define the role of TCAP flap in the head and neck reconstruction strategy. Twenty-one flaps were dissected from 11 formalin-embalmed and 2 fresh cadavers. Flaps were raised distally to proximally, the TCAP was isolated and then injected with watercolor dye to delineate its vascular territory. One fresh cadaver underwent contrast injection, followed by angiography and cone beam computed tomography. In parallel, an in vivo Doppler ultrasonography study was conducted on 50 volunteers to measure the diameter and origin of TCAP. This anatomical study found that anterior thoracic perforator artery consistently originated from the transverse cervical artery with a median diameter of 1.6 mm, as confirmed using cone beam computed tomography. Anterior thoracic perforator artery was located between the clavicle (inferiorly), anterior scalene muscle (deeply), sternocleidomastoid muscle (medially), and omohyoid muscle (laterally). The median vascularized skin territory was 201.1 cm². the Doppler study identified the anterior thoracic perforator artery in 75 of 100 cases, with 98% of them arising from the transverse cervical artery in its scalenic section. The TCAP exhibits consistent anatomical landmarks that originate mainly from the transverse cervical artery in its scalenic section. Preoperative identification using Doppler ultrasonography can help to determine its course, diameter, and accessibility.