The supraclavicular artery island sai flap is a local fasciocutaneous flap taken from skin on the shoulder and supraclavicular area that is gaining popularity for reconstruction of head and neck defects. It features consistent anatomy, a large pedicle and thick but pliable skin. Pallua first described the modern scaif in 1996 and its application. The anatomy of the supraclavicular nerve during surgical. 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. The supraclavicular flap for reconstruction of postburn. The supraclavicular lymph nodes on the left side are called virchows nodes.
Supraclavicular flap repair in the free flap era trautman. Clinical application and surgical details for the reconstruction of composite defects of the nose. Supraclavicular artery flap is a fasciocutaneous flap based on supraclavicular artery, a branch of the transverse cervical artery, less frequently it arises from, the suprascapular artery, though reliable, is not a very large vessel. In our view, the supraclavicular flap, a thin flap of good texture, is an excellent and highly reliable flap for covering defects of the anterior neck. Nov 17, 2017 supraclavicular flap scf repair is widely reported in head and neck surgery in select patients and defects. Supraclavicular artery perforator flap in management of postburn. The supraclavicular artery island flap scaif is a useful. Pdf update on the supraclavicular flap researchgate.
We recommend that supraclavicular flaps of more than 22 cm in. References references herr mw, emerick ks, deschler dg. 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. Supraclavicular artery island flap in head and neck reconstruction. Supraclavicular artery flap for head and neck oncologic reconstruction.
The supraclavicular flap is considered the workhorse of local neck reconstruction flaps due to a number of advantages, namely quick harvesting technique, close match as regards texture and colour of neck skin, a very wide arc of rotation and relatively long pedicle if designed as an island flap, allowing nearly all of the flap surface area to be settled in relatively large defects. Supraclavicular lymph nodes are lymph nodes found above to the clavicle, that can be felt in the supraclavicular fossa. 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. The supraclavicular sc ln flap is an ideal flap for vascularized lymph node transfer, however it is not commonly used due to concern over its reliable anatomy and sufficient number of lymph nodes. The fascial component of the flap the dorsal thoracic fascia can be harvested alone as a free fascial flap. The scapular flap has become clinically popular because it provides a large area of fasciocutaneous tissue and is relatively straight forward to harvest. Local flaps in facial reconstruction brings you the detailed visual guidance and unmatched expertise you need to achieve the best results for the full range of. Jan 12, 2015 one of the best properties of the supraclavicular artery island flap is not only the color and texture but the thickness of the flap. This makes it an ideal flap in circumstances where a large volume of thin, pliable tissue is needed for resurfacing of the neck or face, particularly in burn contracture patients.
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. Chiu editorial comment the mobility of this flap has been widely extended with proximal dissection of the vasculature. There are multiple approaches to blockade of the brachial plexus, beginning proximally with the interscalene block and continuing distally with the supraclavicular, infraclavicular, and axillary blocks. In 1979, lamberty 5 described the supraclavicular artery flap, an axial flap taken from the shoulder and supraclavicular area. One of the main advantages is that it is a thin and pliable flap. Head and neck oncologic resections often leave complex defects which are challenging to reconstruct. 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. Ideal for oral and maxillofacial surgeons, facial plastic surgeons, and head and neck surgeons, the book serves as a useful guide to planning reconstructive. Nov 06, 20 harvest of the supraclavicular flap for oral cavity and total laryngectomy reconstruction. Clinical study, clinical report by international journal of surgical oncology. Dec 12, 20 this feature is not available right now. Supraclavicular artery island flap in head and neck.
Health, general excision surgery patient outcomes physiological aspects head and neck cancer care and treatment plastic surgery methods surgery, plastic. The supraclavicular artery flap scaf was first described as an axial patterned flap by lamberty in 1979. Closure of tracheocutaneous fistula using prefabricated. 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. Kulenkampffs recommendation was to advance the needle toward the first rib, in the direction of the spinous process of t2 or t3, which carries an inherited risk for pneumothorax. These branches provide sensation to the region of the flap over the shoulder.
Pdf on sep 24, 2018, syfyan ahmed and others published supraclavicular flap find, read and cite all the research you need on researchgate. We use the scaif routinely as a firstline option for many of our soft tissue head and neck reconstructions. 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. A practical approach provides comprehensive, stepbystep instruction for flap raising and insetting for the head and neck region. The supraclavicular island flap scif has been extensive used for head and neck reconstructions during the last two decades. Closure of tracheocutaneous fistula using prefabricated conchal bowl cartilage and a supraclavicular flap volume 3 issue 8 n mundi, k b patel, d h yeh, a c nichols. Supraclavicular artery island flap iowa head and neck. A video supported by the american head and neck society. The supraclavicular artery flap for lateral skull and scalp. Advancing education, research, and quality of care for the head and neck oncology patient.
Supraclavicular artery perforator flap in management of. Use of dual, tubularized supraclavicular artery island flaps. The brachial plexus is formed by the ventral rami of c5c6c7c8t1, occasionally with small contributions by c4 and t2. The learning curve can be a significant factor for this flap, due to anatomic variations and patient morphology.
Spyelite intraoperative perfusion assessment system. It is less bulky than the pm flap and can be rotated up to 180 degrees. Recent findings current literature regarding the supraclavicular flap has described its expanded uses in a variety of head and neck reconstructive settings. Sep 30, 2016 in other words, besides a free flap, e.
In this a study we assessed the usefulness of the supraclavicular artery flap in head and neck. Mar 10, 2019 free and regional flaps for head and neck reconstruction by the ahns reconstructive committee free flaps medial sural artery perforator flap new added march 10, 2019 gracilis myocutaneous free flap latissimus dorsi myocutaneous free flap fibula osteocutaneous free flap harvest anterolateral thigh myocutaneous free flap harvest osteocutaneous radial forearm free flap harvest and plating. Supraclavicular artery island flap carver college of medicine. Local and regional flaps in head and neck reconstruction. Supraclavicular artery flap is a fasciocutaneous flap based on supraclavicular artery, a branch of the transverse cervical artery, less frequently it arises from, the suprascapular artery, though reliable, is not a. Jun 26, 2016 supraclavicular artery island flap michael w. The purpose of this study is to describe the supraclavicular flap and its utility in head and neck reconstruction in the context of recent studies. The supraclavicular flap in head and neck reconstruction. Supraclavicular artery island flap plastic surgery key. This is due to its reasonable width that is used to completely fill the neck defect, i. The supraclavicular artery island sai flap is a local fasciocutaneous flap taken from skin on the shoulder and supraclavicular area that is gaining popularity for. Supraclavicular artery perforator flap in management of post. The width of the flap is determined by the laxity of the neck skin allowing primary closure, and can be as large as 24cm x 8cm.
Baker md local flaps in facial reconstruction pdf local flaps in facial reconstruction by by shan r. 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. The supraclavicular lymph node flap has several advantages, including modifiable arterial and venousbased harvest, multiple lymph node donor flap permutations, and no reported associated iatrogenic lymphedema. Duplex ultrasound can be performed before the operation to identify the supraclavicular artery and ensure the integrity of the pedicle. Being a place of concentration of major perceptive organs. It is keystone in perception of selfidentity and represents the most striking features of an individuals being. The supraclavicular artery flap for head and neck reconstruction. Intervention or exposure supraclavicular artery flap reconstruction of defects at various head and neck subsites. Colorectal cancer is the third commonest cause of cancer death in uk. Patient was placed in supine position with bags under shoulder and ipsilateral hand is extended. Sep 06, 2018 the supraclavicular block was introduced into clinical practice in germany by kulenkampff in 1911.
Buchmann1 1division of otolaryngology, department of surgery, university of. Aug 12, 2016 the supraclavicular artery island flap has recently become increasingly used for the reconstruction of complex softtissue defects after head and neck oncologic ablative procedures. Supraclavicular artery island flap by justin wei on prezi. We describe a case of a patient with adenocarcinoma of the descending colon who presented preoperatively with a right supraclavicular swelling. The supraclavicular artery flap for lateral skull and scalp defects. Supraclavicular artery flap for head and neck oncologic.
The supraclavicular artery island flap pocket dentistry. Supraclavicular flap scf repair is widely reported in head and neck surgery in select patients and defects. Pdf on sep 24, 2018, syfyan ahmed and others published. Subsequent imaging and cytology of the lesion revealed this to be a metastasis to the right clavicle resulting in a. Forehead reconstruction using supraclavicular flap with. The supraclavicular artery island flap in head and neck. However, the flap extension is limited to the reconstruction of the superior third of the face, which may increase the risk of distal flap necrosis. Safe supraclavicular artery island flap scaif harvest using. This flap is easy to harvest, with good functional and aesthetic results. The purpose of this study is to describe the supraclavicular flap and its utility in head and neck reconstruction in the. In an aging population with multiple comorbidities, with surgery often being performed in the salvage setting, many patients who are not good candidates for free tissue transfer are in still need of advanced. Moreover, a new subtype based on the anterior supraclavicular artery perforator flap has been harvested with satisfactory results. This site is like a library, use search box in the. 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. Click download or read online button to get local and regional flaps in head and neck reconstruction book now. Supraclavicular artery island flap iowa head and neck protocols. The 3rd and 4th cervical nerves merge and then arborise into 3 tto 5 branches, forming the supraclavicular nerves 22 choice for reconstruction of skin figure 6. An unexpected supraclavicular swelling world journal of.
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