Supraclavicular Artery Island Flap
MICHAEL W. CHU
ERNEST S. CHIU
The mobility of this flap has been widely extended with proximal dissection of the vasculature. It is less bulky than the PM flap and can be rotated up to 180 degrees.
The supraclavicular flap is based on the supraclavicular artery, which is a branch from the transverse cervical artery that originates from the thyrocervical trunk. Kazanjian and Converse (1) first described the supraclavicular flap in 1949 and referred it as the acromial flap. In 1983, Lamberty (2) named it the supraclavicular artery flap and the flap was widely published until it fell out of favor when it was criticized by Blevins and Luce (3) for a high incidence of distal flap necrosis.
Recent trends in reconstructive surgery to minimize donor site morbidity and the advent of perforator flaps have popularized the supraclavicular artery island flap (SCAIF) again. Previous concerns of distal tip ischemia have been addressed with modifications in operative technique, cadaveric perfusion studies (4), and radiographic imaging (5).
The supraclavicular flap is a thin, pliable, fasciocutaneous flap for neck, cervicofacial, and anterior chest wall reconstruction. It is also an option for patients who are not candidates for microvascular free flaps. The supraclavicular flap has been used to reconstruct circumferential pharyngeal (6), parotidectomy (7), and scapular defects (8), as well as cervicofacial and mentosternal burn contractures (9); chest wall (10) and anterior, middle, and posterior skull base defects (11, 12); tracheostomal reconstruction (13); and intraoral resurfacing (14). It can be used as an axial, rotational, transposition, interpolated, or turnover flap, as well as a free tissue transfer. The SCAIF can be used to import vascular inflow, fill volumetric defects, or provide cutaneous coverage for head and neck defects.
An advantage of the supraclavicular fasciocutaneous flap is it is not as bulky as a musculocutaneous flap, such as the pectoralis major flap, which is essential in tracheostoma reconstructions to avoid narrowing the airway or obstructing tracheoesophageal prostheses used in esophageal speech. A disadvantage of the SCAIF is that the vascularity of the flap is most tenuous at the distal portion, which is usually where a vascularized flap is most needed.
Relative contraindications for the supraclavicular flap are prior history of cervical lymphadenectomy and neck irradiation because of concern for injury to the supraclavicular artery. However, the transverse cervical artery has been shown to be fairly reliable despite prior radiation or neck dissection (15).
The supraclavicular artery is a branch of the transverse cervical artery that originates from the thyrocervical trunk. It can be reliably found in the supraclavicular triangle between the sternocleidomastoid, clavicles, and trapezius (Fig. 220.1). On rare occasion, it can originate from the subclavian, internal mammary, or the suprascapular artery (16, 17).