Supraclavicular artery island flap scaif is emerging as an efficient and reliable flap for various complex head and neck defects after tumor extirpation. The supraclavicular artery island flap is a fasciocutaneous flap harvested from the supraclavicular and deltoid regions. 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. 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. Pdf wiz free pdf converter that converts and edits pdf. 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. The supraclavicular artery island flap pocket dentistry.
Advancing education, research, and quality of care for the head and neck oncology patient. The scapular flap has become clinically popular because it provides a large area of fasciocutaneous tissue and is relatively straight forward to harvest. Supraclavicular flap over the last decade, the supraclavicular. Regional flap options include the pectoralis major, rectus abdominis muscle, and omentum flaps. Extended supraclavicular flap is a reliable and versatile flap for soft tissue reconstruction of the head and neck region. 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. 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 supraclavicular artery flap for lateral skull and scalp defects. Use of dual, tubularized supraclavicular artery island flaps. Original article reduced incidence of postoperative symptoms.
Sep 30, 2016 in other words, besides a free flap, e. Safe supraclavicular artery island flap scaif harvest using. Sternal wound coverage using the supraclavicular artery. Thee r joouurnnaall c off l neeww yoorrkk schh oool m a y 2 0. Versatile design of the expanded scalp flap can distribute the expanded hairbearing scalp properly in the. The supraclavicular artery island flap in head and neck. Introduction the supraclavicular flap is based on the supraclavicular artery, which is.
Supraclavicular artery island flap iowa head and neck. The purpose of this study is to describe the supraclavicular flap and its utility in head and neck reconstruction in the. It is less bulky than the pm flap and can be rotated up to 180 degrees. Supraclavicular flap scf repair is widely reported in head and neck surgery in select patients and defects. The supraclavicular flap in head and neck reconstruction. Supraclavicular flap for head and neck reconstruction vula. The need of the hour is a versatile flap which has the advantages of both a regional flap viz. Being a place of concentration of major perceptive organs. A video supported by the american head and neck society. In 1979, lamberty 5 described the supraclavicular artery flap, an axial flap taken from the shoulder and supraclavicular area. 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.
The supraclavicular artery island flap scaif is a useful. Supraclavicular artery island flap in head and neck. After a relatively seamless integration of the technique, this flap has successfully been used to reconstruct a variety of defects. Supraclavicular flap repair in the free flap era trautman. Pallua first described the modern scaif in 1996 and its application. 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 supraclavicular island flap scif has been extensive used for head and neck reconstructions during the last two decades.
Buchmann1 1division of otolaryngology, department of surgery, university of. 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. Safe supraclavicular artery island flap scaif harvest. The supraclavicular artery island flap maxillofacial plastic and. These branches provide sensation to the region of the flap over the shoulder. In this case report, we will report the first use of this flap in. Indications for reconstruction of mucosal defects in. It features consistent anatomy, a large pedicle and thick but pliable skin. We have also found that the supraclavicular flap can be safely elevated provided that it is within 20 x10 cm.
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. 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. 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. In this a study we assessed the usefulness of the supraclavicular artery flap in head and neck. 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. Efficiacy of ultrasound guided supraclavicular blocks. 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. Clinical study, clinical report by international journal of surgical oncology. Supraclavicular artery island flap iowa head and neck protocols. Supraclavicular flap for reconstruction of the face. 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. 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.
Jun 26, 2016 supraclavicular artery island flap michael w. With larger defects, the bilateral supraclavicular flap is an alternative choice. Locoregional and microvascular free tissue reconstruction of. Moreover, a new subtype based on the anterior supraclavicular artery perforator flap has been harvested with satisfactory results. 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. Intervention or exposure supraclavicular artery flap reconstruction of defects at various head and neck subsites. Dec 12, 20 this feature is not available right now. 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 island flap plastic surgery key.
Supraclavicular artery flap for head and neck oncologic. It is keystone in perception of selfidentity and represents the most striking features of an individuals being. The supraclavicular flap for reconstruction of postburn. Harvest of the supraclavicular flap for oral cavity and total laryngectomy reconstruction. Supraclavicular flap reconstruction following total laryngectomy. The supraclavicular artery flap for lateral skull and scalp. Health, general excision surgery patient outcomes physiological aspects head and neck cancer care and treatment plastic surgery methods surgery, plastic. Original article reduced incidence of postoperative symptoms following a novel bilateral supraclavicular approach to open thyroidectomy. 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. 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. Jan 19, 2018 the use of a supraclavicular island flap scif for reconstruction of facial and neck skin defects is increasing. 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. Summary the supraclavicular flap has shown dependability in reconstruction of defects in the head and neck, and it warrants consideration among reconstructive.
Supraclavicular artery flap for head and neck oncologic reconstruction. Patient was placed in supine position with bags under shoulder and ipsilateral hand is extended. Pdf the supraclavicular flap for reconstruction of post. 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. Supraclavicular flap for reconstruction of the face the aesthetic and functional role of the human face can not be overemphasized. The fascial component of the flap the dorsal thoracic fascia can be harvested alone as a free fascial flap. Supraclavicular artery perforator flap in management of postburn. Additional studies are investigating the possibility of neurotized flap. 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.
Pdf update on the supraclavicular flap researchgate. In previous publications, we have noted significant advantages for the sai flap over the pectoralis major flap or free flaps. We use the scaif routinely as a firstline option for many of our soft tissue head and neck reconstructions. Spyelite intraoperative perfusion assessment system. Nov 17, 2017 supraclavicular flap scf repair is widely reported in head and neck surgery in select patients and defects. Supraclavicular flap practice patterns and outcomes.
Supraclavicular artery island flap by justin wei on prezi. In recent years, this flap has been used in specialized centres for the reconstruction of mucosal defects in head and neck cancer patients. The supraclavicular artery flap for head and neck reconstruction. Supraclavicular lymph nodes are lymph nodes found above to the clavicle, that can be felt in the supraclavicular fossa. Pdf on sep 24, 2018, syfyan ahmed and others published supraclavicular flap find, read and cite all the research you need on. Some patients have noted sensation referred to the shoulder after this flap. Free expanded scalp flap for reconstruction of the temporal hair line. 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 advantages are short operative time, short learning curve, minimal rates of failure and lesser donor site morbidity. Head and neck oncologic resections often leave complex defects which are challenging to reconstruct. In those cases, the pedicled flap vascularized by supraclavicular artery could. 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. 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. The supraclavicular lymph nodes on the left side are called virchows nodes.
One of the main advantages is that it is a thin and pliable flap. This is due to its reasonable width that is used to completely fill the neck defect, i. 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. Forehead reconstruction using supraclavicular flap with. References references herr mw, emerick ks, deschler dg. 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. 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. Supraclavicular artery flap, head and neck reconstruction, facial reconstruction. Nov 06, 20 harvest of the supraclavicular flap for oral cavity and total laryngectomy reconstruction. All statistical analysis was performed using commercially available software sas, version 9. Supraclavicular artery perforator flap in management of post.
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