The anterior supraclavicular artery perforator asap flap. The most current, complete, and relevant reference available to date in the fastchanging field of plastic and reconstructive surgery a new fullcolor design throughout, with redrawn illustrations, color figures, and vibrant clinical photographs, enhances the clinical usefulness of the text seven new chapters in volume 1 cover recent developments in the f, supraclavicular artery island. Local and regional flaps in head and neck reconstruction. Methods six imaging techniques were used for supraclavicular artery mapping in 65 cases. Many new developments have taken place in the field, including the use of local perforator flaps, including freestyle propeller flaps as well as. Better understanding of vascular anatomy and pattern of skin circulation has become possible by numerous cadaveric studies. The aim of this study is to assess imaging techniques to define the precise vascular boundaries of this flap. Microsurgery imap flap head and neck reconstruction.
Supraclavicular artery island flap in head and neck. Reconstruction of fullthickness cheek defects with a. The artery arises 3 cm above the clavicle at a distance of about 8 cm. Cordova a, darpa s, pirrello r, brenner e, jeschke j, moschella f. Purchase preexpanded perforator flaps, an issue of clinics in plastic surgery, volume 441 1st edition. Supraclavicular artery island flap for reconstructing defects in the head and neck region. Evolution of flaps has continued after the introduction of fasciocutaneous and musculocutaneous flaps. The supraclavicular artery island flap in head and neck. The supraclavicular fasciocutaneous island flap was actually introduced by lamberty in 1979. The spy was used to assess flap perfusion immediately after harvest with evidence of adequate perfusion to the distal tip and confirmation that the supraclavicular artery pedicle was intact figure 2. It features consistent anatomy, a large pedicle and thick but pliable skin. A study of the use of the supraclavicular artery flap for. Combined deep inferior epigastric perforator flap with gastroepiploic lymph node.
Supraclavicular flap is a fasciocutaneous flap based on branch of transverse cervical artery. Nov 06, 20 harvest of the supraclavicular flap for oral cavity and total laryngectomy reconstruction. He correctly described the supraclavicular artery as a perforator that arises from the transverse cervical artery in 93% of cases or from the suprascapular artery in 7% of cases. Supraclavicular artery perforator flap in management of post. Chiu 34 pectoralis major flap, 396 william ignace wei, chan yu wai expert commentary hungchi chen 35 deltopectoral flap and internal mammary artery perforator flap, e87 j. Perforator flaps have evolved, and they have provided many new flaps with new pedicles all over the body presenting important advantages. After the description by pallua et al 6 of the sai flap in 1997, much of the literature that followed described its use in treating cervical scar contracture. Journal of plastic reconstructive and aesthetic surgery. Mar 26, 2010 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. It marks a new era in reconstructive surgery where surgeons are no longer bound by the traditional conventions of flap surgery. A video supported by the american head and neck society. Perforator flap surgery was described as extravagant and exceptional in those days but it has now become the mainstream reconstructive technique for restoring. Anatomical basis of clavicular crossarea perforator flaps. Background the supraclavicular artery flap is an excellent flap for head and neck reconstruction.
A comparative study of imaging techniques used in preoperative mapping background the supraclavicular artery flap is an excellent flap. It can be used as pedicled, free or even as perforator flap. While myocutaneous flaps such as the pectoralis major or trapezius flap are widely used, perforator propeller flaps are not considered as first line procedure for these indications yet. Anatomical and clinical studies of the supraclavicular flap. Versatility of the supraclavicular pedicle flap in head.
The supraclavicular flap has been favored for head and neck reconstruction due. The reader will find that these extraordinary statements are well supported by the case examples in the book. Dec 12, 20 supraclavicular artery skin island flap duration. As a result, widespread use of perforator flaps, either pedicled or free, has become possible. Also, the supraclavicular flaps that are greater than 23 cm in length results in an increased risk of distal necrosis, with statistically significant relation, p 0. References references herr mw, emerick ks, deschler dg. Introduction the supraclavicular flap was reported first by lamberty in 1979. Pre expansion allows the reconstruction of extended cervical and facial defects. A clinical experience of the supraclavicular flap used to reconstruct head and neck defects in latestage cancer patients. To unify the widely varying nomenclature and in the light of the new classifications regarding perforator flaps, we propose to rename the flap as the supraclavicular artery perforator sap flap. Island supraclavicular artery flap with an easy learning curve is a reliable flap. It is less bulky than the pm flap and can be rotated up to 180 degrees. Supraclavicular artery perforator flap in management of postburn.
Preexpanded supraclavicular artery perforator flap kidney. The scapular flap has become clinically popular because it provides a large area of fasciocutaneous tissue and is relatively straight forward to harvest. Anatomical study of supraclavicular perforator artery and its. Supraclavicular flap is an excellent fasciocutaneous flap for head and neck reconstruction due to its close color and texture match. Flaps and reconstructive surgery by fuchan wei and samir. The vessels that supply blood to the flap are isolated perforator s derived from a deep vascular system through the underlying muscle or intermuscular. Supraclavicular flap is an excellent fasciocutaneous flap for head and. Many of the contributors to perforator flaps for breast reconstruction have pioneered the procedures presented in their respective chapters. Recently, the authors have modified the sap flap by using an anterior branch. Supraclavicular artery island flap iowa head and neck. For instance, a perforator can be integrated into a transposition flap in order to. This site is like a library, use search box in the.
The first ever international course on perforator flaps icpf was organized in gent, belgium, 20 years ago in 1997, when perforator flap surgery was still in its pioneering phase. Transverse cervical artery perforator propeller flap for. Perforator flap surgery is a technique used in reconstructive surgery where skin andor subcutaneous fat are removed from a distant or adjacent part of the body to reconstruct the excised part. The free supraclavicular transverse cervical artery perforator flap. The supraclavicular fasciocutaneous island flap was actually introduced by lamberty and cormock in 1979. Scaif is a fasciocutaneous flap that is very reliable and both easy and quick to harvest.
The supraclavicular artery flap for head and neck reconstruction. For the first time all current information about existing perforator flaps has been gathered in one comprehensive work. It may be a free transverse rectus abdominis myocutaneous tram, a free diep, or a gluteal free flap. This issue of clinics in plastic surgery, guest edited by drs. As is the case with other perforator flaps, the surgical dissection can be difficult. Perforator flaps has two volumes, a total of 1096 pages, and 972 references. Section b local and free flaps in the chest, 387 33 supraclavicular artery flap, 387 michael r. Supraclavicular artery island flap by justin wei on prezi.
Imaging studies for perforator flaps preoperative planning and. This book is an essential authoritative guide for plastic surgeons interested in making perforator flap reconstruction part of their practice. Use of magnetic resonance angiography to better define the supraclavicular lymph. Jan 12, 2015 the flap harvest is depicted in figures 19. Medial, intermediate and lateral supraclavicular nerves 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. Supraclavicular artery flap is an excellent pedicled fasciocutaneous flap taken from skin of the shoulder and supraclavicular area for head and neck reconstruction. Supraclavicular artery perforator flap in management of postburn neck reconstruction. This new edition has been updated to include ten new chapters and extensive updates on all existing chapters. The supraclavicular artery island flap scaif is a pedicled flap that has recently gained great popularity for reconstruction of most head and neck sites, because of its unusual versatility and wide arc of rotation.
Read preexpanded perforator flaps, an issue of clinics in plastic surgery, e book by lee l. An anatomical basis for the flap using a pedicle containing a cervical, nonperforating cutaneous branch of. Preexpanded perforator flaps, an issue of clinics in plastic. Perforator flaps have provided freedom of flap design with over 350.
This results in an ellipse with its anterior longitudinal arc skirting the lateral border of the latissimus. Pu and chunmei wang, is devoted to preexpanded perforator flaps. The author has also successfully applied this flap in the clinic in numerous cases. The supraclavicular artery island flap pocket dentistry. Moreover, a new subtype based on the anterior supraclavicular artery perforator flap has been harvested with satisfactory results. Supraclavicular artery perforator flap anatomical study, imaging findings, and clinical applications. The supraclavicular artery island flap scaif is a fasciocutaneous, axial pattern, local. A new pedicled or free perforator flap based on the anterior supraclavicular vessels.
Click download or read online button to get local and regional flaps in head and neck reconstruction book now. Chiu 34 pectoralis major flap, 396 william ignace wei, chan yu wai expert commentary hungchi chen 35 deltopectoral flap and internal mammary artery perforator flap, e87. The fascial component of the flap the dorsal thoracic fascia can be harvested alone as a free fascial flap. Supraclavicular artery island flap plastic surgery key. Advancing education, research, and quality of care for the head and neck oncology patient. Supraclavicular artery flap for head and neck oncologic.
See how to make optimal use of perforator flaps for reconstruction of the mandible, maxilla, forehead, lower extremity pedicled flaps for reconstruction of shoulder motion in brachial plexus palsy anterolateral thigh flaps for reconstruction of defects in the head and neck, upper extremity, and lower extremity temporoparietal fascia flap for ear reconstruction nerve grafts for. In 1983, lamberty and cormack published an article about the vascular anatomy of the flap to demonstrate its reliability, although the use of the flap progressively decreased, and no more mention of it was made in. Code 19364, breast reconstruction with free flap, is the appropriate code to report free flap breast reconstruction, regardless of the specific free flap used. The supraclavicular flap was reported for the first time by lamberty in 1979 as a thin and pliable fasciocutaneous flap. The perforator can be at the center, distal or proximal aspect of the flap, depending on the needed orientation in the recipient area. Supraclavicular artery perforator flap in management of. This article describes the anatomical basis, flap harvesting technique and the main characteristics of the supraclavicular artery island flap. May 11, 2016 the supraclavicular artery island flap scaif is a pedicled flap that has recently gained great popularity for reconstruction of most head and neck sites, because of its unusual versatility and wide arc of rotation. It has a good colour and texture match with minimal donor site morbidity. Seven parts organized anatomically detail flaps used. The supraclavicular flap has been used for the coverage of defects over the sternum, neck, trachea, retroauricular area, cheek, and oral cavity.
Since that time, the flap has been widely used and reported on. The history of shoulder flap started in 1842 with mutter 11, but only in 1979 lamberty 1 described the axial pattern of the shoulder flap based on the supraclavicular artery. Request pdf the supraclavicular artery perforator flap. Jun 26, 2016 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. Safe supraclavicular artery island flap scaif harvest using. In those cases, the pedicled flap vascularized by supraclavicular artery. A flap of dimensions 15 x 8 cm can be harvested on a single perforator. 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. Code 19364 is not limited to a particular type of free flap, and it is the. It is always located in a triangle delineated by the posterior border of the sternocleidomastoid muscle medially, the external jugular vein posteriorly, and the median portion of the clavicle anteriorly. With coverage of nearly twice the number of flaps as the previous edition, flaps and reconstructive surgery, 2nd edition provides trainees and practicing surgeons alike with the detailed, expert knowledge required to ensure optimal outcomes.
The flap is a good asset for the surgeon, as it is versatile and can. These flap dimensions are similar to those of other reports using the sai flap for reconstruction of oncologic defects of the head and neck. This book includes complimentary access to a digital copy on. The flap was not reported on further until pallua reported its use in cases of neck contracture reconstruction in 1997. The flap dimensions needed are outline, with the perforator on the longitudinal axis of the flap. Supraclavicular island flap for oropharyngeal reconstruction michael w. Previous concerns of distal tip ischemia have been addressed with modifications in operative technique, cadaveric perfusion studies 4, and radiographic imaging 5. It may be necessary to do a book incision in the neck skin if the. Preexpanded perforator flaps, an issue of clinics in plastic surgery volume 441 the clinics. Cordova a, pirrello r, darpa s, jeschke j, brenner e, moschella f 2008 vascular anatomy of the supraclavicular area revisited. Supraclavicular artery island flap iowa head and neck protocols. In larger case series the major complication rate is flaps in 79 patients. Chiu editorial comment the mobility of this flap has been widely extended with proximal dissection of the vasculature. The aim of this study is to assess the relationship between the length and distal end necrosis of the supraclavicular flap.
Supraclavicular flaps that can also be raised as island flaps. It is an excellent choice for neck coverage after post burns contracture release and an attractive alternative to free flap for oral facial defects. Supraclavicular artery island flap, not perforator flap. Reconstructive options for oncologic posterior trunk. The constant supraclavicular artery measures 1 to 1.
Supraclavicular flap for reconstruction of the face. Anatomic study on the transverse cervical vessels perforators in the lateral triangle of the neck and harvest of a new flap. The flap is easy to harvest and boasts shorter operative times than ftt. The indications for supraclavicular artery island flap were therefore extended to head and neck reconstruction, particularly in the context of head and neck cancer, in the 2000s. Grabbs encyclopedia of flaps volume 1 fourth edition free. Introduction the supraclavicular flap is based on the supraclavicular artery, which is. As a regional flap it can be used for closure of defects in lower neck and lateral areas of the face 7.
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. The marked supraclavicular artery island flap was then harvested in a standard fashion 1. Grabbs encyclopedia of flaps volume 1 fourth edition. In general, long flaps are required, but with the risk of distal necrosis. It combines the advantages of pedicled local flaps good color and texture match, likewithlike reconstruction, pedicled regional flaps up to 180 arc of rotation, pedicled distant flap vascular reliable and larger size, and without microsurgical vascular anastomosis. Seven new chapters in volume 1 cover recent developments in the f, supraclavicular artery island flap for head and neck oncologic reconstruction and sensate thoracodorsal artery perforator flap. Apr 02, 2016 pedicled perforator flaps are also called local perforator flaps, or island perforator flaps. The supraclavicular artery perforator sap flap is a versatile flap for the reconstruction of head and neck defects. The supraclavicular flap for reconstruction of postburn. From the supraclavicular artery island flap to the anterior supraclavicular artery perforator flap. Supraclavicular artery perforator flap anatomical study. The name supraclavicular island flap is historically based and describes only one method of flap usage. Soft tissue defects at the supraclavicular region often require coverage by local, distant or free flaps.
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