The supraclavicular flap has gained popularity in recent years as a reliable and easily harvested flap, which is ideal for head and neck reconstruction. The flap is based off an axial vessel branching from the thyrocervical trunk or transverse cervical artery. The color match, thinness, pliability, and the hair-free skin of supraclavicular artery flap parallel that of the head and neck region and provide a superior cosmetic outcome when compared to free tissue transfer flaps from the other regions such as the forearm, abdomen, or thigh [1-3].

Computerized tomography angiography showed best results in the mapping of the supraclavicular artery, but with an inability to define the perforator perfusion territories, and also with risks of irradiation, while indocyanine green angiography is a good alternative as it could precisely map the superficial course of the artery and angiosomes, with no radiation exposure.

The supraclavicular flap has gained popularity in recent years as a reliable and easily harvested flap with occasional anatomical variations in the course of the pedicle. In this case study, the excision of a cancer lesion on the face of 70-year-old female patient had resulted in a soft tissue defect of size 8 x 9 cm. The reconstruction of the surgical defect was done by using the supraclavicular perforator flap. The flap perforators were marked preoperatively with a handheld Doppler using indocyanine green angiography. During the flap dissection, the dominant perforator was determined by a selective clamping of each of the perforators guided by the indocyanine green angiography. Though the distal perforator was determined to be the dominant one, the pedicled flap design was found to be of inadequate length to reach the surgical defect. Consequently, the flap was turned into a free flap. The pedicle was anastomosed to the branches of facial vessels and survived completely. In conclusion, we believe that the dominant perforator may be identified by intraoperative indocyanine green angiography which would help in making a proper decision for flap design.

Background  The use of diced cartilage grafts in rhinoplasty is well described and it has been popularized recently for establishment and camouflaging any imperfections of the dorsal aesthetic lines and contour.  Objectives To establish the efficacy of pure diced cartilage grafts fixed with blood in dorsal nasal refinement or augmentation. Patients and Methods Twenty six rhinoplasties patients (23 primary and 3 secondary) were included in this study. At the end of the procedure, diced cartilage grafts, fixed with blood, were inserted into the dorsum of the nose for dorsal augmentation and camouflage of any imperfections. These cases were subsequently assessed clinically and photographically 3 months, 6 months, and then every 6 months till 2 years postoperatively.  Results At the regular follow up visits, only 3 patients had problem that required treatment. Two patients had palpable bony prominences at the keystone area, which were successfully treated by fine rasping under local anesthesia in clinic, and the other one had a small depression which was filled up.  Conclusions The use of diced cartilage grafts admixed with clotted blood is an elegant and powerful technique in dorsal nasal refinement and augmentation without the additional morbidity, risks and complications incurred in the use of either Surgicel® or with fascia to wrap the cartilage grafts.

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