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 flap is a fasciocutaneous pedicled flap first described by lamberty in 1979 1. The supraclavicular artery flap for lateral skull and scalp defects. Request pdf supraclavicular artery flap supraclavicular arterybased flaps provide aesthetic and functional coverage for the head and neck region. Oral cancer reconstruction using the supraclavicular artery island flap. In the realm of head and neck reconstruction, many would agree that the pendulum has swung back from free tissue transfer ftt to locoregional flaps. Properties of supraclavicular flap raising a supraclavicular flap is a simple quick procedure, usually done in less than an hour, and is a relatively easy to learn procedure. The radial forearm free flap, first described in chinese literature in the 1980s, is a skin and fascial flap based on the radial artery and its venaecomitantes. The supraclavicular artery island flap in head and neck. 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 in head and neck reconstruction.
The supraclavicular artery island flap maxillofacial plastic and. The supraclavicular artery island flap scaif is a fasciocutaneous pedicled flap that is gaining an increased popularity over recent years, thanks to its high versatility, and has been proposed for reconstruction of many head and neck defects. We directly compare the outcomes of reconstructions performed with scaifs and free fasciocutaneous flaps fffs, which have not been reported previously. In adherence to accme standards for commercial support, audio digest requires all faculty and members of the planning committee to disclose relevant financial relationships within the past 12 months that might create any personal conflicts of interest. Since that time, the flap has been widely used and reported on. The supraclavicular artery island flap scaif in head and.
Clinical study supraclavicular artery flap for head and neck oncologic reconstruction. Reconstruction of fullthickness cheek defects with a. Pdf on sep 24, 2018, syfyan ahmed and others published supraclavicular flap find, read and cite all the research you need on researchgate. Supraclavicular flap practice patterns and outcomes. Granzow jw, suliman a, roostaeian j, perry a, boyd jb. Chavan, 1 andrajshekarhalkud 1 department of head and neck surgery, kidwai memorial institute of oncology, bangalore, karnataka, india department of surgical oncology, hcg hospital. This is a free operative surgery text, and is intended particularly for those surgeons in the developing world who are unable to afford textbooks. However, its lymph node content has not been fully studied.
Clinical study supraclavicular artery flap for head and. The supraclavicular flap has been favored for head and neck reconstruction due. A free supraclavicular flap fscf was intended to be used, but during superficial temporal vessels dissection, the vein was severed at the zygomatic arch level. Surgeons experienced fewer pectoralis major flap p free flap p flap which has the advantages of both a regional flap viz. The anterolateral thigh flap, based on the descending branch of the lateral. Of the various flap techniques that are available, the supraclavicular flap is excellent in terms of its match with the color and texture of the recipient area and the simplicity of the operative procedure 412. The author has also successfully applied this flap in the clinic in numerous cases. It has a good colour and texture match with minimal donor site morbidity. It provides a relatively large flap for neck resurfacing with tissue very similar to that of the neck. The supraclavicular lymph node flap sclnf has been described as one of the flap options for vlnt. As a regional flap it can be used for closure of defects in lower neck and lateral areas of the face 7.
An anatomical basis for the flap using a pedicle containing a cervical, nonperforating cutaneous branch of. In those cases, the pedicled flap vascularized by supraclavicular artery could be considered as an alternative to free flap. Its reliability and limited morbidity have been well demonstrated, and it. All donor defects could be closed primarily without significant postoperative complications in seven of the eight patients.
Between january 20 and march 2015, 20 patients suffering from post. The supraclavicular artery island flap is a fasciocutaneous flap harvested from the supraclavicular. Conclusion this represents a novel technique for closure of such fistulas in patients for whom previous attempts have failed. Supraclavicular island flap for oropharyngeal reconstruction michael w. The use of supraclavicular free flap with vascularized lymph. In those cases, the pedicled flap vascularized by supraclavicular artery could be. Supraclavicular pedicled flap is not only an alternative to free flap reconstruction, but also a firstchoice option in head and neck reconstructive surgery. Head and neck versatility of the supraclavicular pedicle. It is an excellent choice for neck coverage after post burns contracture release and an attractive alternative to free flap. Supraclavicular artery island flap iowa head and neck protocols.
The supraclavicular artery island flap is a fasciocutaneous flap harvested from the supraclavicular and deltoid regions. The purpose of this study was to evaluate the flap and the donor site morbidity of the supraclavicular sc vlnt. However, the flap extension is limited to the reconstruction of. Nov 06, 20 harvest of the supraclavicular flap for oral cavity and total laryngectomy reconstruction. Eleven cases underwent supraclavicular artery flap between. The role of free tissue transfer for head and neck burn. Vascular anatomy of the supraclavicular area revisited. Feasibility of the free supraclavicular perforator flap.
Importance the supraclavicular artery island sai rotational flap may have advantages compared with free tissue transfer in head and neck reconstruction. Supraclavicular artery island flap iowa head and neck. The aim of this study is to assess the relationship between the length and distal end necrosis of the supraclavicular flap. The need of the hour is a flap which has the advantages of both regional flap reliable and easy to harvest and free flap thin. 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. Technique refinements have improved the rate of flap survival and decreased. The fasciocutaneous supraclavicular artery island flap for r. Supraclavicular flap is an excellent fasciocutaneous flap for head and neck reconstruction due to its close color and texture match. In addition, donor site morbidity is low due to the natural redundancy of skin in the supraclavicular region. Then, two perforators at the deltoid muscle level were marked with the assistance of a handheld doppler. Clinical study, clinical report by international journal of surgical oncology.
All patients had acceptable functional and aesthetic outcomes. Although free tissue transfer has been the workhorse for larger defects, the supraclavicular artery island flap scaif has emerged as an efficient and reliable flap choice for various head and neck defects. Supraclavicular flaps for the reconstruction of neck scar contractures. Chiu definition the oropharynx is the middle part of the pharynx from the level of the soft palate to the epiglottis and is bordered superiorly by the nasopharynx and the hypopharynx inferiorly. Advancing education, research, and quality of care for the head and neck oncology patient. The supraclavicular flap is a thin, axial, fasciocutaneous flap that may be.
It can be used as pedicled, free or even as perforator flap. 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. Current literature regarding the supraclavicular flap has described its expanded uses in a variety of head and neck reconstructive settings. Elderly cancer patients also have some risk for microvascular surgery with lengthened general anesthesia. Welz c, canis m, schwenkzieger s, spiegel jl, weiss bg, pilavakis y. Nov 17, 2017 supraclavicular flap scf repair is widely reported in head and neck surgery in select patients and defects. The supraclavicular flap operative techniques in otolaryngology. Due to the complex anatomy of the head and neck, a wide range of pedicled or free flaps must be available to ensure optimal reconstruction of the various defects resulting from cancer surgery. Also major complications are far less compared to other flaps. Objectives to report our series of diverse reconstructions utilizing the sca flap and to highlight several technical aspects of flap harvest that. Because this flap has not been extensively described for head and neck reconstruction of oncologic defects, guidelines for its indications would benefit the reconstructive surgeon.
Head and neck versatility of the supraclavicular pedicle flap. Despite several authors have demonstrated the clinical reliability of supraclavicular artery island flap scaif, to date, scaif has not been widely used among reconstructive surgeon. Supraclavicular flap scf repair is widely reported in head and neck surgery in select patients and defects. In this a study we assessed the usefulness of the supraclavicular artery flap in head and neck oncologic defects. Supraclavicular artery flap for head and neck oncologic. Supraclavicular artery island flap for reconstructing defects in the head and neck region. The aim of the present clinical study was to evaluate the feasibility of a folded extended supraclavicular fasciocutaneous island flap sfif for fullthickness cheek defect reconstruction following ablative oral cancer surgery. View enhanced pdf access article on wiley online library html view download pdf for offline viewing.
In general, long flaps are required, but with the risk of distal necrosis. The supraclavicular flap is easy to harvest without the need for free tissue transfer. Health, general excision surgery patient outcomes physiological aspects head and neck cancer care and treatment plastic surgery methods surgery, plastic. Pedicled supraclavicular artery island flap versus free. The need of the hour is a versatile flap which has the advantages of both a regional flap viz. The supraclavicular artery island flap pocket dentistry.
The nine patients with advanced squamous cell carcinoma of the buccal mucosa were six men and three women, with a mean age of 60. Supraclavicular flap for reconstruction of the face. Mean harvest time of supraclavicular artery flap was 50 minutes in our study, similar to that seen in chiu et al. Buchmann1 1division of otolaryngology, department of surgery, university of utah, salt lake city, utah, united states. Versatility of the supraclavicular pedicle flap in head.
The use of regional fasciocutaneous supraclavicular flap with prefabricated conchal bowl cartilage resulted in successful closure of the tracheocutaneous fistula. Recent findings current literature regarding the supraclavicular flap has described its expanded uses in a variety of head and neck reconstructive settings. 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. The flap is highly reliable and since the procedure is shorter than. 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. Introduction the supraclavicular flap was reported first by lamberty in 1979. Jan 12, 2015 the flap harvest is depicted in figures 19.
Versatility of the supraclavicular pedicle flap in head and. Supraclavicular flaps for the reconstruction of neck scar. With an axis of rotation close to the neck, flap positioning is easier with minimum morbidity. The anterolateral thigh flap, based on the descending branch of the lateral circumflex artery, supplies a large amount of skin. The lymph node content of supraclavicular lymph node flap.
Supraclavicular artery flap for head and neck oncologic reconstruction. 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. A simple approach of tubularizing the supraclavicular flap for circumferential pharyngoesophageal defects. Flap survival, speech and swallowing function, and donorsite morbidity at the 6month followup were evaluated. Reconstruction of head and neck defects after tumor extirpation is often challenging and time consuming. We use magnetic resonance angiography mra to delineate number. The supraclavicular artery island flap is a fasciocutaneous flap harvested from the.
The flap is a good asset for the surgeon, as it is versatile and can correct multiple types of defects. The flap was not reported on further until pallua reported its use in cases of neck contracture reconstruction in 1997. The aim of this study is to find out the lymph node content of sclnf with histological examination. Supraclavicular artery island flap scaif vs free fasciocutaneous flaps for head and neck reconstruction. Supraclavicular flap for head and neck reconstruction vula.
The supraclavicular flap can be employed as a rotation flap, tunnelled flap, super charged flap or as a free microvascular transfer flap. Large and deep defects in foreheads are best repaired with flaps. The supraclavicular flap in head and neck reconstruction. Supraclavicular artery island flap in head and neck. The supraclavicular artery flap for lateral skull and. Conclusion supraclavicular flap has several advantages over the conventionally used flaps for head and neck reconstruction. In these types of cases, reconstructions are made through the transfer of distant flaps, due to the small amount of available local tissue. Closure of tracheocutaneous fistula using prefabricated. Supraclavicular flap is a fasciocutaneous flap based on branch of transverse cervical artery. A new pedicled or free perforator flap based on the anterior supraclavicular vessels. Flap and donor site complications were registered for each patient. We believe that we should study the advantages and disadvantages of each type of flap, including the supraclavicular flap, based on strict evaluations. Forehead reconstruction using supraclavicular flap with.
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. Clinical application and surgical details for the reconstruction of composite defects of the nose. The supraclavicular artery island flap scaif is a fasciocutaneous, axial pattern, local. A video supported by the american head and neck society. The flap was planned to be 4 to 10 cm in width and 20 to 30 cm in length with the supraclavicular vessels running axially. The supraclavicular island flap scif has been extensive used for head and neck reconstructions during the last two decades. Mean harvest time in radial free forearm flap is 76 min 9 and additional time for microvascular anastomosis prolongs surgery compared to supraclavicular artery flap. Data sources pubmed, web of science, and embase databases. Supraclavicular flap repair in the free flap era trautman.
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