Neurovascular myocutaneous infrahyoid flap скачать в хорошем качестве

Neurovascular myocutaneous infrahyoid flap

Dr Ramesh B A A rectangular skin paddle centered over the infrahyoid muscle and the cricothyroid region is marked out. When the defect extends laterally, the flap is raised from the adjacent side; if it is median, the flap is raised from either side. The inferior attachments of the sternohyoid and sternothyroid muscles are detached from the sternal notch. Laterally, the superior portion of the omohyoid muscle is separated from the lower segment. The medial boundary of the flap is defined by the linea alba. The infrahyoid flap (IHF) is elevated from lateral to medial and from bottom to top. Dissection progresses above the level of the thyroid gland capsule until reaching the upper thyroid pole, where the terminal branches of the superior thyroid artery are ligated. The common and external carotid arteries are dissected until the superior thyroid artery is exposed. All veins draining the flap towards the internal jugular vein must be preserved, along with the superior thyroid vein. The flap is secured by suturing the skin and muscles together. Subsequently, the insertion of the sternothyroid and thyrohyoid muscles is released from the thyroid cartilage's subperichondral layer. Dissection continues until reaching the hyoid bone, and the infrahyoid muscles are detached from the hyoid bone's posterior aspect. Finally, the flap is transferred to cover the defect.