Original Investigation |

The Supraclavicular Artery Flap for Head and Neck Reconstruction

Marc W. Herr, MD1; Kevin S. Emerick, MD1; Daniel G. Deschler, MD1
[+] Author Affiliations
1Division of Head and Neck Surgery, Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Boston
JAMA Facial Plast Surg. 2014;16(2):127-132. doi:10.1001/jamafacial.2013.2170.
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Published online

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.

Design, Setting, and Participants  A retrospective review was conducted from July 2011 to December 2012 on all patients who had undergone SCA flap reconstruction of a head and neck defect at a tertiary referral center. The average follow-up time was 8 months.

Intervention or Exposure  Supraclavicular artery flap reconstruction of defects at various head and neck subsites.

Main Outcome and Measure  Reconstructive outcomes and complications were assessed and cases were reviewed to identify key aspects of flap harvest.

Results  Twenty-four SCA flaps were performed on defects at multiple head and neck subsites. Several technical modifications were developed to increase the safety and efficiency of flap harvest. Complications were typically self-limited and were successfully managed nonsurgically.

Conclusions and Relevance  The SCA flap is a versatile and reliable reconstructive option for head and neck defects. There are 4 key steps to making the harvest of this flap safe, reliable, and efficient.

Level of Evidence  4

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Figure 1.
A Fusiform Skin Paddle Designed Over the Ventrolateral Aspect of the Deltoid

The course of the supraclavicular artery and vein over the clavicle is confirmed by Doppler and denoted with an “x.”

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Figure 2.
Bilateral, Subdermal Skin Flaps Raised to the Approximate Width of the Skin Paddle

At the clavicle, the subdermal elevation extends from the lateral attachments of the sternocleidomastoid to a point 3 cm lateral to the identified pedicle as it crosses the clavicle.

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Figure 3.
The Flap Raised in a Subfascial Plane Over the Deltoid Muscle in a Distal to Proximal Direction
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Figure 4.
Fascial Pedicle Encompassing the Supraclavicular Vessels

A fascial pedicle encompassing the flap vessels and approximating the width of the skin paddle is maintained to protect the vascular pedicle and prevent kinking or undue tension at inset.

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Figure 5.
Prominent Vessel Within the Deltopectoral Groove and Anterolateral to the Clavicle

This vessel may be ligated to provide more pedicle length without compromising the blood supply.

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Figure 6.
The Supraclavicular Artery Flap Rotated Through the Subcutaneous Tunnel and Inset Into the Surgical Defect

The donor site is closed primarily.

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