Galeal Pedicle Flap of the Occipital Region for Pharynx Reconstruction: Anatomic and Clinical Considerations

Abstract

Surgeons are still searching for the ideal method for pharynx reconstruction after tumor ablation. The objective of this study was to prove the anatomic and clinical viability of an occipital galeal pedicle flap for hypopharynx reconstruction. We studied anatomic details in 50 fresh adult cadavers. The dissections were performed after posterior galea exposure, silicone injection in occipital vessels, and mobilization of the galeal flap with an 8 x 8 cm square of galea. We also used the proposed flap in three clinical cases after laryngopharyngectomy. The surgical technique and its problems are described. Some of the anatomic data obtained are as follows: occipital artery diameter, 2.69 mm (mean); occipital artery length, 134.25 mm; area of occipital vessels network on galea, 148.77 cm2; pedicle length, 116.63 mm; and success in rotation to pharynx region (100 percent). The flap showed good functional and cosmetic results when used in three patients. A partial necrosis occurred in one case. The pedicled galeal occipital flap has favorable anatomic characteristics for use in head and neck reconstruction. Additional studies are necessary to provide more substantial information about its clinical viability.

Imaging and Quantitative Assessment of Long Bone Vascularization in the Adult Rat Using Microcomputed Tomography

“…Duvall et al 2004 used lead chromate suspended in a silicon-based polymer for imaging peripheral vascularization in mice hindlimbs, and found that the image quality was better than that obtained with barium sulfate. This contrast agent has been also used for evaluating bone grafts (de Magalhaes et al, 1998), flat bone vascularization Value are presented as means AE SEM (standard error of the mean). P < 0.01.…”

Combination of vascularized outer-table calvarial bone graft based on the superficial temporal vessels and allomatrix for the repair of an orbito-frontal blow-out fracture in a child

“…The use of vascularized calvarial bone flaps in craniofacial reconstruction has been well documented in the literature (Jackson et al, 1986;Psillakis et al, 1986;Musolas et al, 1991;de Magalhaes et al, 1998). Other reconstructive options such as the use of free grafts either from the rib or the skull and the use of synthetic materials are available.…”

“…De Magalhaes et al (1998), Cutting et al (1984 and Casanova et al (1986) have all studied the anatomy and vascular supply of the scalp and skull bones especially in the fronto-parietal area to look for possible osseous flaps which may be safely used. There is a vast network of anastomoses between the different layers of the scalp.…”

“…Free grafts are simple but in many cases may be partially resorbed. Vascularized calvarial bone is increasingly being used for craniofacial reconstruction (Jackson et al, 1986;Psillakis et al, 1986;Musolas et al, 1991;de Magalhaes et al, 1998). There have been several anatomical studies on the blood supply of the calvaria with the intention of its transfer Tolhurst et al, 1991).…”

Transparapharyngeal and transpterygoid transposition of a pedicled occipital galeopericranial flap: A new flap for skull base reconstruction

“…The anatomy of the occipital scalp is well described in the literature 5–10. The occipital artery (OA) is the fifth tributary of the external carotid system 6 and the main vessel supplying the posterior scalp (Figs.…”