The Tunneled Supraclavicular Island Flap: An Optimized Technique for Head and Neck Reconstruction

Abstract

Reconstructive procedures in the head and neck region use a wide range of flaps for defect closure. The methods range from local, mostly myocutaneous flaps and skin grafts to free microsurgical flaps. To ensure a satisfactory functional and aesthetic result, good texture and color of the flap are always essential. Moreover, the donor-site defect needs to be reduced, with no resulting functional or aesthetic impairment. We have found that the shoulder is a region providing an optimum skin texture match to the neck and face. In cadaver dissection, a vascular pedicle extending from the transversal cervical artery with two accompanying veins was found to vascularize a defined region around the shoulder cap. In line with these findings, the previously described fasciocutaneous island flap, nourished by the supraclavicular artery, was developed further and used purely as a subcutaneously tunneled island flap. The tunneling maneuver significantly improves the donor site by reducing scarring. The flap is characterized by a long subcutaneous pedicle of up to 20 cm. The pivot point is in the supraclavicular region and allows the flap to be used in the upper chest, neck, chin, and cheek. In this article, we introduce the anatomic features and present clinical cases underlining the surgical possibilities of the flap in reconstructive procedures with expanded indications.

The faciocervicopectoral flap for non-oncological cases of cheek reconstruction

“…13 Pallua and Magnus Noah used the supraclavicular artery island flap to reconstruct skin defects of the cheek, chin, neck and chest. 14 The clavicular region was acknowledged as the most suitable donor site for resurfacing the defect. The traditional subclavicular flaps in this region were conventionally pedicled by the perforators of internal thoracic arteries or intercostal arteries.…”

Surgical Corrections in a Patient with Face & Neck Burn Deformity

“…explained that skin of the neck is thin and pliable and it is prone to the formation of contractures, which can affect the movement of neck and the function of the lower The Supraclavicular artery arises from the transverse cervical artery (TCA) about 2-3 cm after the origin of TCA from the first 15 part of the subclavian artery . Though Lamberty has given the name to this artery , up to now misconceptions about the terminology still exist, and the angiosomes have not been 14,16 defined exactly . The boundaries of the flap fall within the skin territories of the Supraclavicular artery.…”

Primary Tracheoesophageal Puncture with Supraclavicular Artery Island Flap after Total Laryngectomy or Laryngopharyngectomy

“…4,5 The supraclavicular artery island flap (SCAIF) is an effective alternative to free tissue transfer and is being used with increasing frequency after laryngectomy. 6,7 The SCAIF has potential associated benefits of a pedicled flap, including improved wound healing and ease of harvest. (Kokot, 2014) There are limited data, however, on primary TEP placement or voice restoration following SCAIF reconstruction, which theoretically should be equivalent to free tissue transfer.…”