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. We have also found that the supraclavicular flap can be safely elevated provided that it is within 20 x10 cm. Technique refinements have improved the rate of flap survival and decreased the complication rate of this. Versatility of the supraclavicular pedicle flap in head. In 1979, lamberty 5 described the supraclavicular artery flap, an axial flap taken from the shoulder and supraclavicular area.
The blood supply of this flap is derived from the supraclavicular artery, a direct cutaneous branch. Objectiveto describe the supraclavicular artery island sai flap as an. 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. We use the scaif routinely as a firstline option for many of our soft tissue head and neck reconstructions. The use of supraclavicular free flap with vascularized lymph node transfer for treatment of lymphedema. Spyelite intraoperative perfusion assessment system.
Local and regional flaps in head and neck reconstruction. Prefabricated vascularised supraclavicular flaps for face. Supraclavicular artery island flap plastic surgery key. 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. The supraclavicular flap is a fasciocutaneous pedicled flap first described by lamberty in 1979 1. The use of supraclavicular free flap with vascularized. The supraclavicular flap is an excellent flap that has been used widely, but its vascular reliability remains unclear. Supraclavicular artery island flap for head and neck oncologic reconstruction. Pdf download for the supraclavicular artery island flap scaif for. The supraclavicular artery island flap pocket dentistry.
Reconstruction of defect with a supraclavicular flap, sixth. 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. Thanks to its particularfeatures and high reliability, it is best indicated for the elderly or most fragile patients. 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. Pdf update on the supraclavicular flap researchgate. 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. Advancing education, research, and quality of care for the head and neck oncology patient. The proposed mechanisms of vlnt include lymphangiogenesis and absorptive action of transplanted lymphatic tissue. Head and neck oncologic resections often leave complex defects which are challenging to reconstruct. Objectivewe have found the supraclavicular artery island flap scaif. The use of the supraclavicular artery flap represents an extremely versatile and useful option for the resurfacing of head, neck and upper torso defects. 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.
The aim of this study is to assess the relationship between the length and distal end necrosis of the supraclavicular flap. All statistical analysis was performed using commercially available software sas, version 9. Grabbs encyclopedia of flaps volume 1 fourth edition pdf preface still the most comprehensive reference available on surgical flaps, this. Supraclavicular lymph nodes radiology reference article. Supraclavicular artery island flap in head and neck. The scapular free flap elrikrh journal of plastic surgery i 982 35, 27 c 1982 the trustees of british association of plastlc surgeons 0007.
In our experience, advantages of this flap were low donor site morbidity, highly reliability, ease of dissection, and no need for microsurgery. This site is like a library, use search box in the. The supraclavicular artery island flap in head and neck. The supraclavicular island flap scif has been extensive used for head and neck reconstructions during the last two decades. 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 artery island flap by justin wei on prezi. 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. Grabbs encyclopedia of flaps volume 1 fourth edition pdf free download. Chiu editorial comment the mobility of this flap has been widely extended with proximal dissection of the vasculature. In those cases, the pedicled flap vascularized by supraclavicular artery could be. Pallua first described the modern scaif in 1996 and its application.
The supraclavicular artery island flap scaif is a thin and pliable pedicled flap that is easy and quick to harvest. Lung herniation after supraclavicular thoracic outlet. Supraclavicular flap for reconstruction of the face. In his initial description of the supraclavicular flap. Complete healing of the flap was observed without any flap loss. The supraclavicular artery flap for lateral skull and scalp defects. The supraclavicular artery island flap scaif for head and neck. 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.
The supraclavicular fasciocutaneous flap is a versatile and useful pedicled flap reconstruction for head and neck defects. Its reliability and limited morbidity have been well demonstrated, and it has been cited as a reasonable alternative to other. The supraclavicular artery island flap in head and neck reconstruction. 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. 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. 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. 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. Supraclavicular flap practice patterns and outcomes. 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 general, long flaps are required, but with the risk of distal necrosis.
Being a place of concentration of major perceptive organs. Patient was placed in supine position with bags under shoulder and ipsilateral hand is extended. Grabbs encyclopedia of flaps volume 1 fourth edition pdf. In this a study we assessed the usefulness of the supraclavicular artery flap in head and neck oncologic. The supraclavicular flap for reconstruction of postburn. After a relatively seamless integration of the technique, this flap has successfully been used to reconstruct a variety of defects. It is less bulky than the pm flap and can be rotated up to 180 degrees. Scaif is very versatile, as it can be used for reconstructionof oral cavity, oropharynx, hypopharynx, facial and cervical skin and tracheostomal defects. The supraclavicular artery island flap is a fasciocutaneous flap harvested from the supraclavicular and deltoid regions. 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. A new autologous blockbone prefabricated flap concept. Anatomical basis of clavicular crossarea perforator flaps. Use of the supraclavicular artery island flap for reconstruction of. References references herr mw, emerick ks, deschler dg.
Use of dual, tubularized supraclavicular artery island. Current literature regarding the supraclavicular flap has described its expanded uses in a variety of head and neck reconstructive settings. Clinical application and surgical details for the reconstruction of composite defects of the nose. The supraclavicular artery island flap scaif is a useful. Buchmann1 1division of otolaryngology, department of surgery, university of. 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. 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. Moreover, a new subtype based on the anterior supraclavicular artery perforator flap has been harvested with satisfactory results. Reconstruction of postburn cervical contractures using. Grabbs encyclopedia of flaps volume 1 fourth edition.
Article information, pdf download for use of the supraclavicular artery. This article describes the anatomical basis, flap harvesting technique and the main characteristics of. The supraclavicular artery flap for lateral skull and. Supraclavicular artery island flap iowa head and neck. Large and deep defects in foreheads are best repaired with flaps. The supraclavicular flap was reported for the first time by lamberty in 1979 as a thin and pliable fasciocutaneous flap. Elderly cancer patients also have some risk for microvascular surgery with lengthened general anesthesia. Here we describe a novel application of dual scaifs used in series for proximal esophageal reconstruction. Therefore, in theory, the lymph node content of lymph node flap is crucial to clinical response. 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.
One of the main advantages is that it is a thin and pliable flap. A study of the use of the supraclavicular artery flap for. It is keystone in perception of selfidentity and represents the most striking features of an individuals being. Introduction the supraclavicular flap is based on the supraclavicular artery, which is. In these types of cases, reconstructions are made through the transfer of distant flaps, due to the small amount of available local tissue.
Forehead reconstruction using supraclavicular flap with. The need of the hour is a versatile flap which has the advantages of both a regional flap viz. Supraclavicular flap for reconstruction of the face the aesthetic and functional role of the human face can not be overemphasized. Systematic studies of cutaneous perforating branches around the clavicle and their anastomosis have not yet been reported. Supraclavicular artery flap for head and neck oncologic. In addition, donor site morbidity is low due to the natural redundancy of skin in the supraclavicular region. Click download or read online button to get local and regional flaps in head and neck reconstruction book now.
To describe american head and neck society ahns surgeon supraclavicular flap scf practice. They oversee the transport of lymph from the thoracic cavity and abdomen. The supraclavicular artery flap for head and neck reconstruction. The lymph node content of supraclavicular lymph node flap. 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 purpose of this study is to describe the supraclavicular flap and its utility in head and neck reconstruction in the. The supraclavicular artery island flap maxillofacial plastic and. The flap was well perfused, and the patient was discharged at postoperative day 5. Supraclavicular artery island flap in head and neck reconstruction.
With larger defects, the bilateral supraclavicular flap is an alternative choice. 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. The supraclavicular artery island flap scaif for head. The flap is easy to harvest and boasts shorter operative times than ftt. Safe supraclavicular artery island flap scaif harvest. Seven patients, presenting facial postburn scars extending over the neck, cheeks, nose, and mandibular area were successfully treated. Supraclavicular flap is an excellent fasciocutaneous flap for head and neck reconstruction due to its close color and texture match. It is the final common pathway of the lymphatic system as it joins the central venous system. However, the flap extension is limited to the reconstruction of. The supraclavicular artery island flap scaif in head and. Lung herniation after first rib resection for thoracic outlet syndrome tos has not been reported to our knowledge.
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