Vascular Anatomy of the Supraclavicular Area Revisited: Feasibility of the Free Supraclavicular Perforator Flap

Abstract

The vascularization of the supraclavicular skin depends on skin perforators coming from the transverse cervical artery and draining into the superficial venous plexus. Based on these vessels, a reliable free supraclavicular flap seems to be safe to harvest, with the scar hidden in the supraclavicular crease. The preliminary clinical applications of such a flap gave promising results, suggesting its potential applications.

Circumferential Pharyngoesophageal Reconstruction with a Supraclavicular Artery Island Flap

“…However, it was 15 This flap, renamed the supraclavicular artery island flap, is now being used with increasing frequency and success in a variety of head & neck reconstructive cases as the anatomy becomes more clearly elucidated. 15,[17][18][19][20][21][22][23] Current single-stage reconstruction methods for circumferential defects include free tissue transfer procedures such as the forearm flap, jejunum, or anterolateral thigh flap. Other regional techniques, such as the pectoralis major, deltopectoral, and trapezius flaps, are alternative pharyngeal reconstruction options.…”

Delineation the anatomy of posterior tibial artery perforator flaps using human cadavers with a modified technique

“…These techniques, however, are not able to intuitively reveal the vascular branches as well as their courses and distribution in flaps [3,5]. Other researchers perform limb vascular perfusion with contrast medium, followed by flap dissection and X-ray photography [14,15], but the method usually masks the actual blood supply of free-grafted pedicle flaps due to the participation of foreign arteries outside the flap range [11,18].…”

Infraclavicular free flap for head and neck reconstruction: Surgical description and early outcomes in 7 consecutive patients

“…They named this vessel the anterior supraclavicular artery perforator (a‐SAP), and thus suggested the name “a‐SAP flap” to describe a fasciocutaneous flap from the infraclavicular region. The a‐SAP was likely the same artery as the AP previously described by Cordova et al However, a significant anatomic inconsistency between these investigations was the vessel's relationship to the omohyoid muscle. A diagram of the a‐SAP was shown to course deep to and under the omohyoid muscle to reach the clavicle as opposed to the Cordova et al, description of the AP, which coursed superficial to and over the omohyoid muscle.…”

“…The a‐SAP was likely the same artery as the AP previously described by Cordova et al However, a significant anatomic inconsistency between these investigations was the vessel's relationship to the omohyoid muscle. A diagram of the a‐SAP was shown to course deep to and under the omohyoid muscle to reach the clavicle as opposed to the Cordova et al, description of the AP, which coursed superficial to and over the omohyoid muscle. Based on our experience, this branch consistently traveled over the omohyoid muscle to cross superficially over the clavicle.…”

“…Several studies have delineated the vascular anatomy, but most of the emphasis has been on the classic supraclavicular artery branch of the TCA because of its proven reliability as a basis for pedicled island flaps . In an anatomic study by Cordova et al, they specifically described a distinct anterior perforator (AP), which arose more proximally from the TCA. This branch coursed over the omohyoid muscle, running in an antero‐inferior direction.…”