In this case report, we will report the first use of this flap in. In recent years, this flap has been used in specialized centres for the reconstruction of mucosal defects in head and neck cancer patients. In 1979, lamberty 5 described the supraclavicular artery flap, an axial flap taken from the shoulder and supraclavicular area. Apr 05, 20 in our experience, advantages of this flap were low donor site morbidity, highly reliability, ease of dissection, and no need for microsurgery. Safe supraclavicular artery island flap scaif harvest. The need of the hour is a versatile flap which has the advantages of both a regional flap viz. 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. 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. The supraclavicular flap for reconstruction of postburn. Supraclavicular artery island flap iowa head and neck. Buchmann1 1division of otolaryngology, department of surgery, university of. Report on the successful use of the supraclavicular flap for reconstruction following total laryngectomy and highlight the utility and versatility of the supraclavicular flap for reconstruction. The brachial plexus is formed by the ventral rami of c5c6c7c8t1, occasionally with small contributions by c4 and t2.
Objective to examine a series of cases using a scaif for head and reconstruction at our institution. Additional studies are investigating the possibility of neurotized flap. Pallua first described the modern scaif in 1996 and its application. Patient was placed in supine position with bags under shoulder and ipsilateral hand is extended.
The supraclavicular artery flap for lateral skull and scalp. Arcand et al compared ultrasound guided supraclavicular to ultrasound guided infraclavicular block and demonstrated that surgical anesthesia was similar in both groups although the radial nerve required more frequent supplementation in the infraclavicular group 5. Locoregional and microvascular free tissue reconstruction of. It features consistent anatomy, a large pedicle and thick but pliable skin. After a relatively seamless integration of the technique, this flap has successfully been used to reconstruct a variety of defects. The supraclavicular artery island flap pocket dentistry. Safe supraclavicular artery island flap scaif harvest using.
Supraclavicular flap for head and neck reconstruction vula. The supraclavicular lymph nodes on the left side are called virchows nodes. The advantages are short operative time, short learning curve, minimal rates of failure and lesser donor site morbidity. Summary the supraclavicular flap has shown dependability in reconstruction of defects in the head and neck, and it warrants consideration among reconstructive. 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. Introduction the supraclavicular flap is based on the supraclavicular artery, which is. The scapular flap has become clinically popular because it provides a large area of fasciocutaneous tissue and is relatively straight forward to harvest. Supraclavicular artery island flap by justin wei on prezi. 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.
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. 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. These branches provide sensation to the region of the flap over the shoulder. Being a place of concentration of major perceptive organs. Sternal wound coverage using the supraclavicular artery. Efficiacy of ultrasound guided supraclavicular blocks. The supraclavicular artery island flap is a fasciocutaneous flap harvested from the supraclavicular and deltoid regions.
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. This is due to its reasonable width that is used to completely fill the neck defect, i. Pdf the supraclavicular flap for reconstruction of post. It is keystone in perception of selfidentity and represents the most striking features of an individuals being. Pdf wiz free pdf converter that converts and edits pdf. Health, general excision surgery patient outcomes physiological aspects head and neck cancer care and treatment plastic surgery methods surgery, plastic. Spyelite intraoperative perfusion assessment system.
Chiu editorial comment the mobility of this flap has been widely extended with proximal dissection of the vasculature. Original article reduced incidence of postoperative symptoms following a novel bilateral supraclavicular approach to open thyroidectomy. Supraclavicular artery island flap iowa head and neck protocols. The supraclavicular artery flap for lateral skull and scalp defects. Supraclavicular flap over the last decade, the supraclavicular. Its reliability and limited morbidity have been well demonstrated, and it has been cited as a reasonable alternative to other reconstructive options including, in some situations, free tissue transfer. Harvest of the supraclavicular flap for oral cavity and total laryngectomy reconstruction. Jun 26, 2016 supraclavicular artery island flap michael w. Supraclavicular flap reconstruction following total laryngectomy. 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. Supraclavicular artery island flap scaif is emerging as an efficient and reliable flap for various complex head and neck defects after tumor extirpation.
Supraclavicular flap practice patterns and outcomes. Supraclavicular artery perforator flap in management of post. Supraclavicular artery island flap plastic surgery key. With larger defects, the bilateral supraclavicular flap is an alternative choice. 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.
The supraclavicular artery island flap in head and neck. Dec 12, 20 this feature is not available right now. We use the scaif routinely as a firstline option for many of our soft tissue head and neck reconstructions. 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. 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. 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. In this a study we assessed the usefulness of the supraclavicular artery flap in head and neck. Supraclavicular artery flap for head and neck oncologic. 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 artery island sai flap is a local fasciocutaneous flap taken from skin on the shoulder and supraclavicular area that is gaining popularity for. Sep 30, 2016 in other words, besides a free flap, e. The fascial component of the flap the dorsal thoracic fascia can be harvested alone as a free fascial flap. Nov 17, 2017 supraclavicular flap scf repair is widely reported in head and neck surgery in select patients and defects.
Some patients have noted sensation referred to the shoulder after this flap. Pdf wiz is a completely free pdf converter that converts pdf to wordpptexcel, images, merge, split or compress pdf or remove pdf password, and more. The supraclavicular flap in head and neck reconstruction. 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 is less bulky than the pm flap and can be rotated up to 180 degrees. Indications for reconstruction of mucosal defects in.
All statistical analysis was performed using commercially available software sas, version 9. In previous publications, we have noted significant advantages for the sai flap over the pectoralis major flap or free flaps. Supraclavicular flap for reconstruction of the face the aesthetic and functional role of the human face can not be overemphasized. Supraclavicular artery island flap in head and neck. Extended supraclavicular flap is a reliable and versatile flap for soft tissue reconstruction of the head and neck region. Intervention or exposure supraclavicular artery flap reconstruction of defects at various head and neck subsites. The supraclavicular artery island flap maxillofacial plastic and. The supraclavicular artery island flap scaif is a useful. The supraclavicular artery flap for head and neck reconstruction. Pdf update on the supraclavicular flap researchgate.
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. We have also found that the supraclavicular flap can be safely elevated provided that it is within 20 x10 cm. Pdf on sep 24, 2018, syfyan ahmed and others published supraclavicular flap find, read and cite all the research you need on. The purpose of this study is to describe the supraclavicular flap and its utility in head and neck reconstruction in the. 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. Supraclavicular artery perforator flap in management of postburn. Supraclavicular flap repair in the free flap era trautman. Supraclavicular artery flap for head and neck oncologic reconstruction.
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. Use of dual, tubularized supraclavicular artery island flaps. Supraclavicular artery flap, head and neck reconstruction, facial reconstruction. Supraclavicular lymph nodes are lymph nodes found above to the clavicle, that can be felt in the supraclavicular fossa. Versatile design of the expanded scalp flap can distribute the expanded hairbearing scalp properly in the. The supraclavicular island flap scif has been extensive used for head and neck reconstructions during the last two decades. Supraclavicular flap scf repair is widely reported in head and neck surgery in select patients and defects. Supraclavicular flap for reconstruction of the face. Head and neck oncologic resections often leave complex defects which are challenging to reconstruct. Jan 19, 2018 the use of a supraclavicular island flap scif for reconstruction of facial and neck skin defects is increasing. Advancing education, research, and quality of care for the head and neck oncology patient.
Incomplete block when using the supraclavicular approach is, in our experience, most commonly due to failure to block the lower trunk, which subsequently results in inadequate ulnar nerve anesthesia. A video supported by the american head and neck society. The same technique is generally used for tunnelled flaps, with the added steps of deepithelialisation of the flap and creation of a subcutaneous tunnel for its. The 3rd and 4th cervical nerves merge to form supraclavicular nerves, which provide sensation to the region of the flap over the shoulder as well as lateral neck and upper chest. A literature search was performed on the internet and pubmed for anatomic and clinical studiesreports in the english language on the supraclavicular artery flap with a minimum of 10 subjects and. Thee r joouurnnaall c off l neeww yoorrkk schh oool m a y 2 0. Moreover, a new subtype based on the anterior supraclavicular artery perforator flap has been harvested with satisfactory results.
References references herr mw, emerick ks, deschler dg. Clinical study, clinical report by international journal of surgical oncology. Forehead reconstruction using supraclavicular flap with. 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. Original article reduced incidence of postoperative symptoms. One of the main advantages is that it is a thin and pliable flap. Regional flap options include the pectoralis major, rectus abdominis muscle, and omentum flaps. In those cases, the pedicled flap vascularized by supraclavicular artery could. Nov 06, 20 harvest of the supraclavicular flap for oral cavity and total laryngectomy reconstruction. Free expanded scalp flap for reconstruction of the temporal hair line.
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