Applied anatomy of supraclavicular artery island flap and preliminary clinical report on reconstruction of tongue

Abstract

To study the anatomy of supraclavicular artery island flap and report the clinical application of the island flap for the reconstruction of tongue defects. The branch, origination, course, length and diameter of transverse cervical artery and supraclavicular artery were observed on 20 flaps of 10 adult cadavers perfused with lead oxide-gel, and the draining veins were also observed. The supraclavicular artery island flaps were used to reconstruct the defects following tongue cancer ablation in 4 patients, and the data concerning functional impairment, aesthetic outcome and donor site morbidity were analyzed. The transverse cervical artery were originated from the thyrocervical trunk or subclavical artery, and separated into deep branch and superficial branch above the middle third of the clavicle. The supraclavicular artery were originated from superficial branch of the transverse cervical artery and extended to backward and outward, and run over surface of trapezius, acromial end of clavicle and deltoid fascia, and then penetrated the deep fascia and go into skin and subcutaneous tissue of supraclavicular and shoulder regions. The distance between the origins of the supraclavicular and transverse cervical arteries was on average 4.3 cm, and the distance between the origin of supraclavicular artery and the point where it penetrated the deep fascia was on average 3.6 cm. The external diameter of the transverse cervical artery was on average 2.7 mm, and the external diameter of supraclavicular artery was on average 1.1 mm. Two supraclavicular comitant veins ran adjacent to the supraclavicular artery and drained into the transverse cervical vein and external jugular vein respectively. In the clinical study, 3 flaps survived completely and part of the skin paddle of the flap in one case exhibited necrosis. The contour and function of tongues were restored well and there was no limitation of shoulder motion in all 4 cases. The supraclavicular artery island flap with supraclavicular artery as nutrient vessel is reliable for reconstruction of oral, maxillofacial and neck defects, and it can be used as a free flap equipped with the transverse cervical artery.