Resumen de Supraclavicular artery perforator flap, anatomical study, imaging findings, and clinical applications
SUMMARY Background Supraclavicular artery flap is an excellent pedicled fasciocutaneous flap taken from the skin of the shoulder and supraclavicular area for head and neck reconstruction. The color match, thinness, pliability, and hair-free skin of supraclavicular artery flap parallels that of the head and neck region and provides a superior cosmetic outcome when compared to free tissue transfer flaps from such as the forearm, abdomen, or thigh.
The purpose of this study is to find the ideal technique for the preoperative mapping of the supraclavicular artery perforator flap, and also to determine the safe survival length of the flap.
Methods Between July 2013 and February 2017, A total of 74 cases were studied, they were aged between 19 and 85 years (mean age of 49.26 years), 32 males and 42 females. In this study, the following six imaging modalities were used for supraclavicular vascular tree visualization: 1) Handheld Doppler (HHD) 2) Triplex ultrasound (TU) 3) Computed Tomography Angiogram (CTA) 4) Magnetic Resonance Angiography (MRA) 5) Digital Subtraction Angiography (DSA) 6) Indocyanine Green Fluorescent Angiogram (ICGA).
Furthermore, 21 patients from the total of 74 cases, underwent head and neck reconstruction surgery, in which 25 supraclavicular flaps were used. Twelve of these cases had flaps following release and excision of burn contractures whereas the remaining 9 patients had flaps following wide excision of tumors. Results Handheld Doppler identified perforators' sites in 80% of the cases but showed no results for the course of the vessel. Triplex ultrasound identified the site of perforators in 52.9% and partial mapping of the course of a supraclavicular artery in 64.7% of the cases. Computerized tomography angiogram showed the site of perforators in 60%, and the course of supraclavicular artery completely in 45%, and partially in an additional 30% of the cases examined. Magnetic resonance angiography showed negative results for all parameters. Digital subtraction angiography showed the partial course of a supraclavicular artery in 62.5% but showed no perforators. Indocyanine green angiogram showed the site of perforators in 60% and a partial course of supraclavicular artery distal to perforators in 60%.
The length of the 25 flaps used varied according to the patient's need. On average the length ranged from 12- 35 cm with a mean length of 20.76 cm. There was no total flap loss, however, 3 of the flaps (12%) resulted in distal end necrosis. The results showed that all the flaps with distal necrosis had a length 23cm or longer. Furthermore, the flaps that had the length below 23 cm had no necrosis, which consists of 14 flaps, (56%).
Conclusion ICG angiogram precisely shows the site of the perforators and superficial course of the artery in the real time of the test. Although CTA performed better in the mapping of the supraclavicular artery, but it has irradiation and the risk of contrast problems.
The distal survival of the supraclavicular artery perforator flap is reliable below 22 cm, but the flaps above that size will increase the risk of distal necrosis.
