Vu Quang Vinh

Anatomical and clinical studies of the supraclavicular flap: analysis of 103 flaps used to reconstruct neck scar contractures.

Background: The supraclavicular flap is an excellent flap that has been used widely, but its vascular reliability remains unclear. In this article, the authors report the results of their anatomical studies on 40 flaps from 20 preserved cadavers and their clinical studies of 103 supraclavicular flaps in 101 patients. Methods: In their anatomical study, the authors analyzed the important anatomical features that are useful for harvesting flaps. In their clinical study, the authors analyzed the cases in terms of flap reliability. Results: The supraclavicular artery branched from the transverse cervical artery in all 40 specimens (100 percent). Although it arose from the middle third of the clavicle in 90 percent of the specimens, it arose from the lateral third of the clavicle in four specimens (10 percent). Moreover, the transverse cervical artery originated from the subclavian artery in two of 40 specimens (5 percent) rather than from the thyrocervical trunk. The origins of the supraclavicular and transverse cervical arteries were on average 4.12 cm apart (range, 3 to 5.5 cm). In our clinical study, 101 of the 103 flaps (98.1 percent) were (vascular-pedicled) island flaps and five (4.9 percent) were transferred under a skin tunnel. We also performed a supercharged flap transfer using posterior circumflex humeral vessels. Of the 103 flaps, 97 survived completely (94.2 percent), but four and two exhibited superficial distal necrosis (3.9 percent) and total necrosis (1.9 percent), respectively. Conclusions: Supraclavicular flaps are reliable, but vascular anomalies exist. In the authors’ experience, the posterior circumflex humeral artery could be used for supercharging the supraclavicular flap.

Clinical and anatomical study of superficial cervical artery flaps: retrospective study of reconstructions with 41 flaps and the feasibility of harvesting them as perforator flaps.

Background: The superficial cervical artery musculocutaneous flap was first reported by Nakajima and Fujino in 1984; the present authors developed it for use as a skin flap in 1990, and in 1993, they succeeded in harvesting it as a free flap. Since 1986, they have harvested 41 superficial cervical artery flaps of various types from 32 patients to reconstruct head and neck scar contractures and intractable ulcers. Methods: In a retrospective clinical study, the authors classified these 41 flaps into three types according to their pedicles: musculocutaneous pedicled flaps (n = 5); muscle pedicled flaps (n = 14), and vascular pedicled flaps (n = 22). In an anatomical study, they harvested 10 flaps from five preserved cadavers and took microangiograms of the trapezius muscle and dorsal skin to identify the distribution of the superficial cervical artery. Results: Thirty-six flaps survived completely, and both the aesthetic and functional results were good. Among the other five flaps, partial necrosis was observed in four and complete necrosis was seen in one. Among the 36 surviving flaps, 23 were more than 30 cm long. Conclusions: The authors fully confirmed from their clinical and anatomical studies that the superficial cervical artery flap is useful for reconstruction of the head and neck regions. In each flap, the superficial cervical artery was found to be a “transverse cervical perforator” or “trapezius perforator” and was large enough to be used as a vascular pedicled flap, suggesting that it can be elevated as a “perforator flap.”

Bipedicled “Superthin” Free Perforator Flaps for Facial Burn Scar Reconstruction: Expanded Scope of Superthin Flaps: A Case Series

Background: “Superthin flap” is a distinctively thin flap that is thinned primarily to the point that the subdermal vascular network can be seen through a minimal fat layer. Reconstruction of severely disfigured neck and face can be performed using the occipito-cervico-dorsal superthin flap that is harvested from the dorsal region and supercharged by the circumflex scapular vessels. We used bipedicled superthin free perforator flaps to reconstruct scar contractures on half of the face, whole face, or the whole chin-neck area in 17 postburn patients. Methods: This case series report includes all 17 cases. Flaps in the dorsal area were designed. In all cases, one pedicle consisted of the circumflex scapular vessels. In 11, 5, and 1 flaps, the second pedicle consisted of contralateral posterior intercostal perforators (type 1), ipsilateral posterior intercostal perforators (type 2), and ipsilateral circumflex scapular vessels (type 3), respectively. Four patients underwent whole-face reconstruction after acid burn with type 1 or type 3 perforator. The recipient vessels were the superficial temporal vessels and contralateral or ipsilateral facial vessels. Intraoperatively, all adipose tissue in the flap, including between the 2 pedicles, was thinned by scissors before the pedicles were detached from the donor sites. Maximum flap size was 35 × 15 cm. Donor sites were covered by a split full-thickness skin graft. Flap survival and functional and cosmetic results were assessed retrospectively. Results: Fifteen of the 17 flaps survived completely. Two developed partial necrosis due to perforator thrombosis. Some patients developed hypertrophic scars around the flap, but these improved naturally over time. All patients were satisfied with both the cosmetic and functional outcomes of the reconstruction. Conclusion: Bipedicled superthin free perforator flaps may be an excellent choice for reconstruction of severe neck scar contracture. This report expands the scope of previously used “superthin flaps.”