The need of the hour is a versatile flap which has the advantages of both a regional flap viz. Spyelite intraoperative perfusion assessment system. Moreover, a new subtype based on the anterior supraclavicular artery perforator flap has been harvested with satisfactory results. It is the final common pathway of the lymphatic system as it joins the central venous system. The scapular free flap elrikrh journal of plastic surgery i 982 35, 27 c 1982 the trustees of british association of plastlc surgeons 0007. The supraclavicular flap was reported for the first time by lamberty in 1979 as a thin and pliable fasciocutaneous flap. In this a study we assessed the usefulness of the supraclavicular artery flap in head and neck oncologic. Supraclavicular artery island flap plastic surgery key. The use of supraclavicular free flap with vascularized lymph node transfer for treatment of lymphedema. One of the main advantages is that it is a thin and pliable flap. It is less bulky than the pm flap and can be rotated up to 180 degrees. The supraclavicular lymph nodes often shortened to the supraclavicular nodes are a paired group of lymph nodes located on each side in the hollow superior to the clavicle, close to the sternoclavicular joint. The supraclavicular artery island flap scaif is a versatile pedicled flap that can be an excellent alternative to free flap reconstruction in complex head and neck defects.
Furthermore, islanding the flap gives it a wide arc of rotation and the color and texture match is superior to that of free flaps harvested from distant sites. We present a unique case of cervical lung herniation causing displacement of the brachial plexus and chronic pain in a patient who had previously undergone supraclavicular thoracic outlet decompression with first rib resection. The purpose of this study is to describe the supraclavicular flap and its utility in head and neck reconstruction in the. The flap is easy to harvest and boasts shorter operative times than ftt.
With larger defects, the bilateral supraclavicular flap is an alternative choice. Prefabricated vascularised supraclavicular flaps for face. The blood supply of this flap is derived from the supraclavicular artery, a direct cutaneous branch of the transverse cervical artery in 93% of cases or the supraclavicular artery in 7% of cases. Lung herniation after first rib resection for thoracic outlet syndrome tos has not been reported to our knowledge. This site is like a library, use search box in the. A study of the use of the supraclavicular artery flap for. During the second stage, after 3 months of skin expansion, the total scarred face is excised and the prefabricated supraclavicular axial flap is dissected and then rotated to cover the skin defect. Grabbs encyclopedia of flaps volume 1 fourth edition pdf preface still the most comprehensive reference available on surgical flaps, this. Pdf update on the supraclavicular flap researchgate.
Supraclavicular lymph nodes radiology reference article. Use of the supraclavicular artery island flap for reconstruction of. The use of the supraclavicular artery flap represents an extremely versatile and useful option for the resurfacing of head, neck and upper torso defects. Safe supraclavicular artery island flap scaif harvest. We sought to comprehensively analyze the cutaneous perforator flaps surrounding the clavicle and their anastomosis to obtain the anatomical evidence for the application of crossarea perforator flaps. Anatomical basis of clavicular crossarea perforator flaps. The supraclavicular artery island flap scaif is a useful. Thanks to its particularfeatures and high reliability, it is best indicated for the elderly or most fragile patients. Flap design and expander application when patients presented with postburn neck contracture and we decided to perform an expanded supraclavicular artery island flap, first the exact site of the supraclavicular artery was identified by means of a duplex scanner. Supraclavicular flap for reconstruction of the face the aesthetic and functional role of the human face can not be overemphasized. The supraclavicular flap is an excellent flap that has been used widely, but its vascular reliability remains unclear.
The supraclavicular artery island flap scaif in head and. We have also found that the supraclavicular flap can be safely elevated provided that it is within 20 x10 cm. Here we describe a novel application of dual scaifs used in series for proximal esophageal reconstruction. Click download or read online button to get local and regional flaps in head and neck reconstruction book now. Its reliability and limited morbidity have been well demonstrated, and it has been cited as a reasonable alternative to other.
In addition, donor site morbidity is low due to the natural redundancy of skin in the supraclavicular region. Forehead reconstruction using supraclavicular flap with. Introduction the supraclavicular flap is based on the supraclavicular artery, which is. Fundamental studies were performed by pallua et al, who in 1997 described the supraclavicular island flap for releasing postburn mentosternal contractures as a reliable and useful flap. The use of supraclavicular free flap with vascularized.
Supraclavicular artery island flap for head and neck oncologic reconstruction. To describe american head and neck society ahns surgeon supraclavicular flap scf practice. Pallua first described the modern scaif in 1996 and its application. The supraclavicular artery island flap scaif for head and neck. Supraclavicular artery island flap by justin wei on prezi.
Grabbs encyclopedia of flaps volume 1 fourth edition pdf. However, regional flaps continue to evolve and still play an important role in a reconstructive surgeons armamentarium, especially for the more delicate patients who would certainly benefit from simpler surgical procedures. We use the scaif routinely as a firstline option for many of our soft tissue head and neck reconstructions. Lung herniation after supraclavicular thoracic outlet. Supraclavicular flap for reconstruction of the face. The supraclavicular island flap scif has been extensive used for head and neck reconstructions during the last two decades. After a relatively seamless integration of the technique, this flap has successfully been used to reconstruct a variety of defects. Clinical application and surgical details for the reconstruction of composite defects of the nose. However, the flap extension is limited to the reconstruction of. The aim of this study is to assess the relationship between the length and distal end necrosis of the supraclavicular flap. The supraclavicular artery island flap is a fasciocutaneous flap harvested from the supraclavicular and deltoid regions. Patient was placed in supine position with bags under shoulder and ipsilateral hand is extended.
The supraclavicular artery island flap in head and neck reconstruction. Grabbs encyclopedia of flaps volume 1 fourth edition. Objectivewe have found the supraclavicular artery island flap scaif. We hypothesize that the pedicled scaif has decreased operating room time, length of stay, time to wound healing of recipient site, complications, and hospital charges as compared with ftt. Some of head and neck cancer patients are in compromised general condition after ablation surgery and chemoradiation therapy, which makes secondary free tissue transfer quite challenging. Importance this study demonstrates the versatility of the supraclavicular artery sca flap in head and neck reconstruction and offers technical highlights to improve the efficiency of flap harvest objectives to report our series of diverse reconstructions utilizing the sca flap and to highlight several technical aspects of flap harvest that make the procedure more safe, reliable, and efficient. The supraclavicular artery island flap pocket dentistry. The supraclavicular artery flap for lateral skull and. We have found the supraclavicular artery island flap scaif to be a reliable, firstline tool for the reconstruction of complex head and neck defects. The supraclavicular fasciocutaneous flap is a versatile and useful pedicled flap reconstruction for head and neck defects. Chiu editorial comment the mobility of this flap has been widely extended with proximal dissection of the vasculature. He described the supraclavicular artery as a distinct branch of the transverse cervical artery in most cases and of the suprascapular artery in a smaller number. In those cases, the pedicled flap vascularized by supraclavicular artery could be.
The supraclavicular artery island flap in head and neck. Seven patients, presenting facial postburn scars extending over the neck, cheeks, nose, and mandibular area were successfully treated. Grabbs encyclopedia of flaps volume 1 fourth edition pdf free download. The supraclavicular artery flap for lateral skull and scalp defects. Use of dual, tubularized supraclavicular artery island. Supraclavicular flap practice patterns and outcomes. In his initial description of the supraclavicular flap. It is keystone in perception of selfidentity and represents the most striking features of an individuals being. References references herr mw, emerick ks, deschler dg. Article information, pdf download for use of the supraclavicular artery.
Being a place of concentration of major perceptive organs. Supraclavicular flap is an excellent fasciocutaneous flap for head and neck reconstruction due to its close color and texture match. Supraclavicular artery island flap iowa head and neck. This article describes the anatomical basis, flap harvesting technique and the main characteristics of. The supraclavicular artery island flap scaif is a thin and pliable pedicled flap that is easy and quick to harvest. Outcomes of the supraclavicular artery island flap scaif have not been extensively studied in comparison with free tissue transfer ftt flaps for head and neck reconstruction. In general, long flaps are required, but with the risk of distal necrosis. Technique refinements have improved the rate of flap survival and decreased the complication rate of this. Therefore, in theory, the lymph node content of lymph node flap is crucial to clinical response. All statistical analysis was performed using commercially available software sas, version 9. Supraclavicular artery island flap in head and neck reconstruction. The proposed mechanisms of vlnt include lymphangiogenesis and absorptive action of transplanted lymphatic tissue. The lymph node content of supraclavicular lymph node flap.
Reconstruction of defect with a supraclavicular flap, sixth. The supraclavicular artery island flap maxillofacial plastic and. A new autologous blockbone prefabricated flap concept. Versatility of the supraclavicular pedicle flap in head. The supraclavicular flap has several advantageous properties which has rendered it a preferred flap for the reconstruction of the lower face and neck for many reconstructive surgeons. Elderly cancer patients also have some risk for microvascular surgery with lengthened general anesthesia. Systematic studies of cutaneous perforating branches around the clavicle and their anastomosis have not yet been reported. The supraclavicular artery flap for head and neck reconstruction. Reconstruction of postburn cervical contractures using. Current literature regarding the supraclavicular flap has described its expanded uses in a variety of head and neck reconstructive settings. Pdf download for the supraclavicular artery island flap scaif for. Scaif is very versatile, as it can be used for reconstructionof oral cavity, oropharynx, hypopharynx, facial and cervical skin and tracheostomal defects. A new autologous blockbone prefabricated flap concept based on the supraclavicular artery island flap scaif for reconstruction of a neomandibular osteoradionecrosis orn defect, ideal stage 1 report. Complete healing of the flap was observed without any flap loss.
The blood supply of this flap is derived from the supraclavicular artery, a direct cutaneous branch. Buchmann1 1division of otolaryngology, department of surgery, university of. Advancing education, research, and quality of care for the head and neck oncology patient. Supraclavicular artery flap is a thin and pliable, versatile, reliable, and easy to harvest, with good cosmetic and functional outcome at both recipient and donor sites for one stage reconstruction of complex head and neck oncologic defects. Local and regional flaps in head and neck reconstruction. Large and deep defects in foreheads are best repaired with flaps. In these types of cases, reconstructions are made through the transfer of distant flaps, due to the small amount of available local tissue. The supraclavicular artery island flap scaif for head. Reconstructive procedures protocols general considerations indications the supraclavicular flap is a thin, axial, fasciocutaneous flap that may be used for reconstruction of trachealstomal, mandible, intraoral, parotid, neck eg.
In our experience, advantages of this flap were low donor site morbidity, highly reliability, ease of dissection, and no need for microsurgery. The supraclavicular flap is a fasciocutaneous pedicled flap first described by lamberty in 1979 1. Supraclavicular artery island flap in head and neck. The flap was well perfused, and the patient was discharged at postoperative day 5. Objectiveto describe the supraclavicular artery island sai flap as an. Still the most comprehensive reference available on surgical flaps, this classic text remains your goto source for practical, authoritative guidance on achieving the best possible outcomes for your patients. In 1979, lamberty 5 described the supraclavicular artery flap, an axial flap taken from the shoulder and supraclavicular area. They oversee the transport of lymph from the thoracic cavity and abdomen.