The pre-expanded subclavicular island flap: A new tool for facial reconstruction

Abstract

The anterior chest is an excellent donor site for cervicofacial reconstruction. Studies of chest flaps began as early as 1988at our institution. We identified a new branch of the supraclavicular artery that nourishes the anterior chest, and on the basis of this finding, we created a new flap called the subclavicular flap. Unlike the supraclavicular flap, which is pedicled by the deltoid branch, this flap is primarily pedicled by the thoracic branch, and it shares similar vascular territory with the deltopectoral flap. In China, this flap has been widely used for neck reconstruction since our first publications on it in 1993. However, reports of its application are limited. To popularize the use of this flap, we present our experiences with pre-expanded subclavicular island flaps for the repair of facial scars. Fifteen patients with facial scars underwent reconstruction with these flaps. All flaps underwent pre-expansion before being transferred to the face through a subcutaneous tunnel. The pivot point was in the supraclavicular region and allowed the flap to reach the mid-face without compulsive positioning. Donor sites were closed primarily. Flaps sizes ranged from 4cm×5cm-10cm×17cm. Fourteen flaps survived completely with satisfactory colour and texture. Total flap loss occurred in one patient, who was then treated by harvesting a skin graft from the dying flap. One patient experienced venous congestion, and the flap was successfully salvaged by pure vein anastomosis. Pre-expanded subclavicular island flaps have similar benefits to supraclavicular and deltopectoral flaps, and they may emerge as one of the best choices for cervicofacial reconstruction globally.