BACKGROUND:   Head & neck oncologic resections often results in complex wounds requiring the use of local, regional, or free tissue transfer to restore form and function.  Microvascular free tissue transfer revolutionized reconstructive surgery in the head and neck by providing more flap options to reliably replace tissue defects with minimal donor site morbidity.  However, they require technical expertise as well as increased operative time.  The supraclavicular artery island (SAI) flap has been successfully used for difficult facial reconstruction cases providing acceptable results without using microsurgical techniques.  Its utility has been demonstrated in reconstructing a variety of head and neck oncologic defects which normally require traditional regional or free flaps to repair surgical wounds.  The SAI flap is a versatile regional flap for head and neck reconstruction; however, the vascular anatomy is poorly understood.  The goal of this study is to determine the vascular anatomy of this flap using computed tomographic (CT) angiography.

METHODS:  SAI flap anatomical dissections were performed to establish the location, caliber, length, and flow of the supraclavicular vessels. Dynamic and static computed tomographic angiography using iodinated contrast media was performed to gain a detailed appreciation of the microvascularity of the flap. Three dimensional images were then created to produce clear and accurate images of the simulated flaps.

RESULTS:  Ten (n=10) SAI flaps were harvested from fresh cadavers from the Western population. The entire skin paddle was perfused in the majority (9/10) of flaps. One of the flaps was perfused only 50%. In this case, the pedicle artery was found to be much smaller than the other flap pedicles.  Direct linking vessels as well as recurrent flow via the subdermal plexus were found to convey the flow of contrast between adjacent perforators .  This explains how perfusion extends to adjacent perforators via inter-perforator flow, and how perfusion is maintained all the way to the distal periphery of the flap.

CONCLUSION: Using a novel dynamic three-dimensional imaging technique, perfusion of the arterial and venous system of the supraclavicular artery island flap was elucidated. 

This vascular study:

i.                   confirms previous clinical findings that the SAI flap is a reliable regional flap

ii.                  identifies advantages/limitations of the SAI vascular anatomy

iii.                 gives surgeons new information for future flap refinement.