Sternocleidomastoid Flap for Pedicled Reconstruction in Head & Neck Surgery- Revisiting the Anatomy and Technique

Background: Previous studies on sternocleidomastoid flaps, have defined the importance of preserving sternocleidomastoid (SCM) branch of superior thyroid artery (STA). This theory drew criticism, as this muscle is known to be a type II muscle, i.e., the muscle has one dominant pedicle (branches from the occipital artery at the superior pole) and smaller vascular pedicles entering the belly of muscle (branches from STA and thyrocervical trunk) at the middle and lower pole respectively. It was unlikely for the SCM branch of STA to supply the upper and lower thirds of the muscle. We undertook a cadaveric angiographic study to investigate distribution of STA supply to SCM muscle.Methods: It is a prospective study on 10 cadaveric SCM muscles along with ipsilateral STA which were evaluated with angiography using diatrizoate (urograffin) dye. Radiographic films were interpreted looking at the opacification of the muscle. Results were analyzed using frequency distribution and percentage. Results:Out of ten specimens, near complete opacification was observed in eight SCM muscle specimens. While one showed poor uptake in the lower third of the muscle, the other showed poor uptake in the upper third segment of muscle. Conclusion: Based on the above findings we propose to re-classify sternocleidomastoid flap as a type III flap as the STA branch also supplies the whole muscle along with previously described pedicle from occipital artery. However, this needs to be further corroborated intra-operatively using scanning laser doppler.

Tako-Tsubo syndrome. Approach to the subject and Report of 2 cases

Takotsubo syndrome, or stress cardiomyopathy, is a relatively rare transient and reversible cardiomyopathy, although its diagnosis has increased in recent years, it presents as an acute coronary syndrome (ACS) or acute heart failure, its incidence is unknown exactly in Latin America and in Cuba. We present 2 cases seen in our hospital, both 63 and 55-year-old women with typical precordial pressure pain, the first triggering psychological stress and the second physical, with electrocardiographic changes consistent with anterior infarction and cardiogenic shock, which were found in the coronary angiographic study observed normal coronary arteries and ventriculography determined apical ballooning of the left ventricle characteristic of the syndrome, with subsequent recovery and favorable clinical evolution at 6 months.

Angiographic Study of the Anatomical Variations of the Anterior Communicating Artery Complex

Introduction: The anterior communicating artery complex consists of two anterior cerebral arteries (ACA), the anterior communicating artery (AComA) and the recurrent arteries of Heubner. ACA is divided into the three segments; A1 originating from the internal carotid artery, A2 extending from AComA and A3 also known as the pericallosal artery. The anatomical variations of the ACoA complex are not adequately discussed. The aim of this study is to detect the anatomical variations in the ACoA complex in patients that don’t have any intracranial vascular pathology. Aims: The present study determines the anatomical Variations of the anterior communicating artery complex. Patients and Methods: The study group consists of 70 subjects, using Digital Subtraction Angiography and Computed Tomography Angiography to visualize the vascular anatomy. Results: About 14.29% (10 patients) Aplastic ACoA, 7.14% (5 patients) have unilateral A1 ACA segment hypoplasia, 2.86% (2 patients) have unilateral A1 ACA segment aplasia. Conclusion: The most common anatomical variant is Aplastic ACoA.