The main arterial sources of the neck structures included branches of the external carotid system. In the subplatysmal space, key structures were found within the various layers of the cervical fascia. The vascular supply in the submental region is shown in Fig. There were a mean of four skin perforators between 4 and 6 cm from the midline. 7 Most of these lymph nodes were found to be located 5–6.5 cm from the midline. also reported a mean of 3☐.6 submental lymph nodes with a size of 4.5 ☑.8 mm×2.9☑.2 mm in the submental area. first described a mean of 3.3☑.5 sizable submental lymph nodes in a 10×5 cm skin paddle inferior to the mandibular line in 2012. 5 Specific technical considerations must be given to the location, preservation, and perfusion of the lymph nodes in the region. Initially, a width of 10×5 cm was used to include the anterior belly of the digastric muscle, and this approach has been altered to 6×2.5 cm (close to the mandibular angle) in order to include one to two skin perforators additionally, a width of 5 cm of the medial part of platysma has been used to avoid the inability to lower the bottom lip, which is a symptom of marginal mandibular pseudoparalysis. Instead, the submental VLN flap skin paddle was designed along the lower margin of the mandible. The submental VLN flap, based on the axis of the facial-submental artery, is not similar in design or elevation to the traditional submental flap, in which a skin paddle was designed in the midline below the chin and used for locoregional soft tissue coverage of the head and neck. Patel, in Principles and Practice of Lymphedema Surgery (Second Edition), 2022 Concepts
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