Prefabricated Induced Expanded (Pie) Supraclavicular Flap

EDITORIAL COMMENT

This is an extremely useful technique. By expansion of the skin, the blood supply appears to be augmented. Flaps that could not be safely transferred previously are now capable of being successfully fabricated and transferred.

Prefabrication of flaps opens interesting, new possibilities (1, 2, 3, 4, 5). The prefabricated induced expanded (PIE) supraclavicular flap involves the staged transfer of expanded supraclavicular skin, with a fascial flap used as a carrier (7, 8). The PIE supraclavicular flap is ideally suited for nasal reconstruction, when a forehead flap option is not available or when a forehead scar is not desirable.

INDICATIONS

Facial defects are best reconstructed with facial tissue. When this option is not available, the next best tissue match is supraclavicular skin, which has no practical vascular pedicle that would allow its transfer as a thin flap. The PIE flap is an ideal alternative for reconstruction of facial units using tissue that
best matches facial tissue. Total cheek, forehead, nasal, and even hemifacial reconstructions are possible with a single PIE flap. With judicious design, the flap can be made large enough to reconstruct major facial defects that extend to the contralateral side well beyond the midline.

ANATOMY

When available, the temporoparietal fascia is the preferred carrier. (For details of flap dissection, see Chapters 58 and 96 on temporoparietal fascia flaps.) If the temporoparietal fascia is not available, the next best alternative is the radial forearm fascial free flap. (See Chapters 202 and 204 for details of flap anatomy.) Any other fascial flap with a long vascular pedicle is suitable as a carrier.

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