Anatomical and clinical studies of the supraclavicular flap: analysis of 103 flaps used to reconstruct neck scar contractures.

Background: The supraclavicular flap is an excellent flap that has been used widely, but its vascular reliability remains unclear. In this article, the authors report the results of their anatomical studies on 40 flaps from 20 preserved cadavers and their clinical studies of 103 supraclavicular flaps in 101 patients.

Methods: In their anatomical study, the authors analyzed the important anatomical features that are useful for harvesting flaps. In their clinical study, the authors analyzed the cases in terms of flap reliability.

Results: The supraclavicular artery branched from the transverse cervical artery in all 40 specimens (100 percent). Although it arose from the middle third of the clavicle in 90 percent of the specimens, it arose from the lateral third of the clavicle in four specimens (10 percent). Moreover, the transverse cervical artery originated from the subclavian artery in two of 40 specimens (5 percent) rather than from the thyrocervical trunk. The origins of the supraclavicular and transverse cervical arteries were on average 4.12 cm apart (range, 3 to 5.5 cm). In our clinical study, 101 of the 103 flaps (98.1 percent) were (vascular-pedicled) island flaps and five (4.9 percent) were transferred under a skin tunnel. We also performed a supercharged flap transfer using posterior circumflex humeral vessels. Of the 103 flaps, 97 survived completely (94.2 percent), but four and two exhibited superficial distal necrosis (3.9 percent) and total necrosis (1.9 percent), respectively.

Conclusions: Supraclavicular flaps are reliable, but vascular anomalies exist. In the authors' experience, the posterior circumflex humeral artery could be used for supercharging the supraclavicular flap.