A Case of Neck Scar Contracture Reconstructed Using a Pedicled Supraclavicular Flap

Abstract

Sir: The supraclavicular fasciocutaneous island flap was introduced by Lamberty in 1979,1 and in 1998, Baudet and Martin reported the clinical application of it as a free flap for hand surgery.2 The supraclavicular flap is thin and highly reliable. In this report, we present a neck scar contracture case reconstructed with good results using the pedicled supraclavicular flap. A 72-year-old man sustained severe flame burns on the neck and chest. Emergency split-thickness skin grafts were applied, but neck scar contractures developed postoperatively. His left shoulder was not burned, so neck reconstruction using a unilateral pedicled supraclavicular flap measuring 16 × 10 cm was designed on the patient’s shoulder. The recipient site determined the size of the flap (Fig. 1).Fig. 1.: A 72-year-old man who sustained severe flame burns on the neck and chest underwent reconstruction using the supraclavicular flap. The flap measured 16 × 10 cm, and the harvested flap included skin, subcutaneous tissue, and the fascia of the deltoid muscle.The recipient-site scars were debrided to the depth of the deep fascia to release the contractures completely. The harvested flap included skin, subcutaneous tissue, and the fascia of the deltoid muscle. In the medial part of the flap, the supraclavicular artery, which arises from the transverse cervical artery, could be identified. The flap could be rotated up to cover the defect after removal of the scar. It survived completely, and the functional and aesthetic results were good (Fig. 2). The donor site was closed with a split-thickness skin graft.Fig. 2.: Six-month postoperative view. The flap survived completely, and the functional and aesthetic results were good.The main vessel of the supraclavicular flap is the supraclavicular artery. The supraclavicular artery is a perforator that arises from the transverse cervical artery in 93 percent of cases and the suprascapular artery in 7 percent.3 It divides into one or two arteries before reaching the deep fascia of the deltoid muscle in the third medial clavicle. These one or two arteries then branch out toward the acromioclavicular joint; when reaching that point, they further divide into small branches that reach the superior part of the deltoid muscle. At this level, they become interfused with the cutaneous branches of the posterior circumflex humeral artery. The supraclavicular artery is also interfused with the vascular network of the musculocutaneous perforator of the trapezius muscle in the dorsal region and with the vascular network of the cutaneous branches of the thoracoacromial artery in the anterior chest.1 In our experience, the average supraclavicular artery is 1.0 to 1.5 mm in diameter, and we have been able to include 3 to 4 cm of vascular pedicle when we harvest island flaps. In some cases, however, this was too short for use in the ipsilateral neck area, so we refined the transverse cervical artery to allow us to harvest longer vascular pedicles. Using our refinement technique, we are able to harvest 5 to 6 cm of pedicle. From our experience, it is possible to harvest flaps of up to 11 cm in width and 21 cm in length. This allows the anterior edge to reach the inferior border of the clavicle, the posterior edge to reach the upper area of the trapezius muscle, and the distal edge to reach the upper arm. Our contention is that the supraclavicular island flap is thin, reliable, and easy to harvest. Vu Quang Vinh, M.D. Department of Plastic and Reconstructive Surgery Nippon Medical School Hospital Tokyo, Japan Department of Plastic and Reconstructive Surgery Vietnam National Institute of Burns Hanoi, Vietnam Rei Ogawa, M.D., Ph.D. Department of Plastic and Reconstructive Surgery Nippon Medical School Hospital Tokyo, Japan Tran Van Anh, M.D. Department of Plastic and Reconstructive Surgery Vietnam National Institute of Burns Hanoi, Vietnam Hiko Hyakusoku, M.D., Ph.D. Department of Plastic and Reconstructive Surgery Nippon Medical School Hospital Tokyo, Japan