The tunneled supraclavicular island flap: An optimized technique for head and neck reconstruction

Reconstructive procedures in the head and neck region use a wide range of f laps for defect closure. The methods range from local, mostly myocutaneous flaps and skin grafts to free microsurgical flaps. To ensure a satisfactory functional and aesthetic result, good texture and color of the flap are al ways essential. Moreover, the donor-site defect needs to be reduced, with n o resulting functional or aesthetic impairment. We have found that the shou lder is a region providing an optimum skin texture match to the neck and fa ce. In cadaver dissection, a vascular pedicle extending from the transversal ce rvical artery with two accompanying veins was found to vascularize a define d region around the shoulder cap. In line with these findings, the previous ly described fasciocutaneous island flap, nourished by the supraclavicular artery, was developed further and used purely as a subcutaneously tunneled island flap. The tunneling maneuver significantly improves the donor site b y reducing scarring. The flap is characterized by a long subcutaneous pedic le of up to 20 cm. The pivot point is in the supraclavicular region and all ows the flap to be used in the upper chest, neck, chin, and cheek. In this article, we introduce the anatomic features and present clinical ca ses underlining the surgical possibilities of the flap in reconstructive pr ocedures with expanded indications.