Vascular anatomy of the supraclavicular area revisited: feasibility of the free supraclavicular perforator flap.
BACKGROUND
The supraclavicular skin has been studied extensively and used as a pedicled flap for face and neck reconstruction. Its use as a free flap has not paralleled its use as a pedicled flap. The authors performed an anatomical investigation to assess the possibility of harvesting a free supraclavicular flap with the donor-site scar lying in the supraclavicular crease. In this article, the authors present the results of their anatomical study together with the preliminary clinical applications.


METHODS
Skin vascularization and feasibility of a free supraclavicular perforator flap were studied on 25 cadavers (15 fresh cadavers injected with colored latex at the Universiteé René Descartes in Paris; and 10 formalin-fixed, noninjected cadavers at the Innsbruck Medical University). The flap was used in two patients at the Plastic Surgery Department of the University of Palermo for a cutaneous facial reconstruction and intraoral reconstruction after cancer excision.


RESULTS
An average of four perforators were consistently found in the supraclavicular area coming from the transverse cervical artery. Venous perforators drain into the superficial venous plexus rather than into the venae comitantes of the transverse cervical artery. Two flaps were successfully used based on these vessels.


CONCLUSIONS
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.
Cordova
Adriana
A
Palermo, Italy; Paris, France; and Innsbruck, Austria From the Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo; the Laboratoire d'Anatomie, Université R. Descartes; and the Department of Plastic and Reconstructive Surgery, Innsbruck Medical University, and the Division for Clinical-Functional Anatomy, Department of Anatomy, Histology and Embryology, Innsbruck Medical University.
Pirrello
Roberto
R
D'Arpa
Salvatore
S
Jeschke
Johannes
J
Brenner
Erich
E
Moschella
Francesco
F
D000368:Aged; D002102:Cadaver; D002280:Basal Cell Carcinoma / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D002560:Cerebrovascular Circulation; D005145:Face / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005887:Gingival Neoplasms / Q000601:surgery; D006801:Humans; D007601:Jugular Veins / Q000033:anatomy & histology; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000033:anatomy & histology / Q000098:blood supply*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012878:Skin Neoplasms / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply*