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. Many of the contributors to perforator flaps for breast reconstruction have pioneered the procedures presented in their respective chapters. References references herr mw, emerick ks, deschler dg. Grabbs encyclopedia of flaps volume 1 fourth edition free. Perforator flaps have evolved, and they have provided many new flaps with new pedicles all over the body presenting important advantages. The supraclavicular artery flap for head and neck reconstruction. The name supraclavicular island flap is historically based and describes only one method of flap usage. Reconstructive options for oncologic posterior trunk. Advancing education, research, and quality of care for the head and neck oncology patient.
A video supported by the american head and neck society. Microsurgery imap flap head and neck reconstruction. Code 19364 is not limited to a particular type of free flap, and it is the. Supraclavicular artery island flap plastic surgery key. The vessels that supply blood to the flap are isolated perforator s derived from a deep vascular system through the underlying muscle or intermuscular. The artery arises 3 cm above the clavicle at a distance of about 8 cm. The supraclavicular flap was reported for the first time by lamberty in 1979 as a thin and pliable fasciocutaneous flap. The supraclavicular artery island flap pocket dentistry. Safe supraclavicular artery island flap scaif harvest using. Chiu editorial comment the mobility of this flap has been widely extended with proximal dissection of the vasculature.
Imaging studies for perforator flaps preoperative planning and. The supraclavicular artery island flap in head and neck. Preexpanded perforator flaps, an issue of clinics in plastic surgery volume 441 the clinics. The flap was not reported on further until pallua reported its use in cases of neck contracture reconstruction in 1997. Perforator flaps has two volumes, a total of 1096 pages, and 972 references. The reader will find that these extraordinary statements are well supported by the case examples in the book. The fascial component of the flap the dorsal thoracic fascia can be harvested alone as a free fascial flap. Jan 12, 2015 the flap harvest is depicted in figures 19. Supraclavicular artery island flap by justin wei on prezi. Anatomical and clinical studies of the supraclavicular flap. Preexpanded supraclavicular artery perforator flap kidney.
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. A new pedicled or free perforator flap based on the anterior supraclavicular vessels. Supraclavicular flap for reconstruction of the face. A flap of dimensions 15 x 8 cm can be harvested on a single perforator. Scaif is a fasciocutaneous flap that is very reliable and both easy and quick to harvest. Local and regional flaps in head and neck reconstruction. 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.
Perforator flap surgery was described as extravagant and exceptional in those days but it has now become the mainstream reconstructive technique for restoring. The flap dimensions needed are outline, with the perforator on the longitudinal axis of the flap. Better understanding of vascular anatomy and pattern of skin circulation has become possible by numerous cadaveric studies. It marks a new era in reconstructive surgery where surgeons are no longer bound by the traditional conventions of flap surgery. Supraclavicular artery perforator flap anatomical study, imaging findings, and clinical applications. As is the case with other perforator flaps, the surgical dissection can be difficult. 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. 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. Journal of plastic reconstructive and aesthetic surgery. Methods six imaging techniques were used for supraclavicular artery mapping in 65 cases. The supraclavicular flap has been favored for head and neck reconstruction due. 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.
A study of the use of the supraclavicular artery flap for. The constant supraclavicular artery measures 1 to 1. Supraclavicular artery perforator flap in management of postburn neck reconstruction. Request pdf the supraclavicular artery perforator flap.
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. The tap flap is well suited for extremity, head and neck, and periarticular resurfacing as well as for the contouring of shallow defects. Supraclavicular artery island flap for reconstructing defects in the head and neck region. This book includes complimentary access to a digital copy on. It has a good colour and texture match with minimal donor site morbidity. Recently, the authors have modified the sap flap by using an anterior branch. 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. Supraclavicular artery perforator flap in management of post. This new edition has been updated to include ten new chapters and extensive updates on all existing chapters.
The scapular flap has become clinically popular because it provides a large area of fasciocutaneous tissue and is relatively straight forward to harvest. This article describes the anatomical basis, flap harvesting technique and the main characteristics of the supraclavicular artery island flap. Supraclavicular flap is an excellent fasciocutaneous flap for head and. Perforator flaps have provided freedom of flap design with over 350. The flap is a good asset for the surgeon, as it is versatile and can. Flaps and reconstructive surgery by fuchan wei and samir. This issue of clinics in plastic surgery, guest edited by drs. Anatomic study on the transverse cervical vessels perforators in the lateral triangle of the neck and harvest of a new flap. 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.
It features consistent anatomy, a large pedicle and thick but pliable skin. Code 19364, breast reconstruction with free flap, is the appropriate code to report free flap breast reconstruction, regardless of the specific free flap used. Evolution of flaps has continued after the introduction of fasciocutaneous and musculocutaneous flaps. 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. Click download or read online button to get local and regional flaps in head and neck reconstruction book now.
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. The aim of this study is to assess the relationship between the length and distal end necrosis of the supraclavicular flap. Supraclavicular artery flap is an excellent pedicled fasciocutaneous flap taken from skin of the shoulder and supraclavicular area for head and neck reconstruction. These flap dimensions are similar to those of other reports using the sai flap for reconstruction of oncologic defects of the head and neck. 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. 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. In general, long flaps are required, but with the risk of distal necrosis. Soft tissue defects at the supraclavicular region often require coverage by local, distant or free flaps. Previous concerns of distal tip ischemia have been addressed with modifications in operative technique, cadaveric perfusion studies 4, and radiographic imaging 5. Seven parts organized anatomically detail flaps used.
It can be used as pedicled, free or even as perforator flap. As a regional flap it can be used for closure of defects in lower neck and lateral areas of the face 7. The aim of this study is to assess imaging techniques to define the precise vascular boundaries of this flap. Grabbs encyclopedia of flaps volume 1 fourth edition. Since that time, the flap has been widely used and reported on. A comparative study of imaging techniques used in preoperative mapping background the supraclavicular artery flap is an excellent flap. Apr 02, 2016 pedicled perforator flaps are also called local perforator flaps, or island perforator flaps. Supraclavicular artery island flap iowa head and neck protocols. Supraclavicular artery island flap, not perforator flap. The author has also successfully applied this flap in the clinic in numerous cases. Supraclavicular artery island flap in head and neck. 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. Anatomical study of supraclavicular perforator artery and its.
Nov 06, 20 harvest of the supraclavicular flap for oral cavity and total laryngectomy reconstruction. The free supraclavicular transverse cervical artery perforator flap. 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. It is an excellent choice for neck coverage after post burns contracture release and an attractive alternative to free flap. Supraclavicular flaps that can also be raised as island flaps. Supraclavicular flap is a fasciocutaneous flap based on branch of transverse cervical artery. The marked supraclavicular artery island flap was then harvested in a standard fashion 1. 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.
Reconstruction of fullthickness cheek defects with a. Supraclavicular flap is an excellent fasciocutaneous flap for head and neck reconstruction due to its close color and texture match. Introduction the supraclavicular flap was reported first by lamberty in 1979. 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. In larger case series the major complication rate is flaps in 79 patients. 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. An overview concept, anatomic study, development, clinical application. From the supraclavicular artery island flap to the anterior supraclavicular artery perforator flap. The flap is easy to harvest and boasts shorter operative times than ftt. Pu and chunmei wang, is devoted to preexpanded perforator flaps.
A clinical experience of the supraclavicular flap used to reconstruct head and neck defects in latestage cancer patients. It is an excellent choice for neck coverage after post burns contracture release and an attractive alternative to free flap for oral facial defects. Background the supraclavicular artery flap is an excellent flap for head and neck reconstruction. 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.
Versatility of the supraclavicular pedicle flap in head. Cordova a, darpa s, pirrello r, brenner e, jeschke j, moschella f. Section b local and free flaps in the chest, 387 33 supraclavicular artery flap, 387 michael r. The supraclavicular artery perforator sap flap is a versatile flap for the reconstruction of head and neck defects. The perforator can be at the center, distal or proximal aspect of the flap, depending on the needed orientation in the recipient area. Purchase preexpanded perforator flaps, an issue of clinics in plastic surgery, volume 441 1st edition. Cordova a, pirrello r, darpa s, jeschke j, brenner e, moschella f 2008 vascular anatomy of the supraclavicular area revisited. 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. It may be necessary to do a book incision in the neck skin if the. Supraclavicular island flap for oropharyngeal reconstruction michael w. 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. 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. Combined deep inferior epigastric perforator flap with gastroepiploic lymph node.
The supraclavicular fasciocutaneous island flap was actually introduced by lamberty in 1979. 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 artery island flap scaif is a fasciocutaneous, axial pattern, local. Preexpanded perforator flaps, an issue of clinics in plastic. Pre expansion allows the reconstruction of extended cervical and facial defects. Many new developments have taken place in the field, including the use of local perforator flaps, including freestyle propeller flaps as well as. Supraclavicular artery perforator flap anatomical study. Supraclavicular artery perforator flap in management of postburn. As a result, widespread use of perforator flaps, either pedicled or free, has become possible. In those cases, the pedicled flap vascularized by supraclavicular artery. The supraclavicular fasciocutaneous island flap was actually introduced by lamberty and cormock in 1979. An anatomical basis for the flap using a pedicle containing a cervical, nonperforating cutaneous branch of. Dec 12, 20 supraclavicular artery skin island flap duration.
The anterior supraclavicular artery perforator asap flap. The supraclavicular flap has been used for the coverage of defects over the sternum, neck, trachea, retroauricular area, cheek, and oral cavity. The supraclavicular flap for reconstruction of postburn. It may be a free transverse rectus abdominis myocutaneous tram, a free diep, or a gluteal free 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.
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. Use of magnetic resonance angiography to better define the supraclavicular lymph. 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. This site is like a library, use search box in the. Supraclavicular artery island flap iowa head and neck. 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.
Transverse cervical artery perforator propeller flap for. For instance, a perforator can be integrated into a transposition flap in order to. Microsurgery double free flap with fibula and alt head and neck reconstruction duration. This results in an ellipse with its anterior longitudinal arc skirting the lateral border of the latissimus. 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. Supraclavicular artery perforator flap in management of. Anatomical basis of clavicular crossarea perforator flaps. Island supraclavicular artery flap with an easy learning curve is a reliable flap. This book is an essential authoritative guide for plastic surgeons interested in making perforator flap reconstruction part of their practice. Read preexpanded perforator flaps, an issue of clinics in plastic surgery, e book by lee l. Introduction the supraclavicular flap is based on the supraclavicular artery, which is. It is less bulky than the pm flap and can be rotated up to 180 degrees.
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