Summary
Background
Recently, the supraclavicular artery island flap has gained popularity as a regional
flap for head and neck reconstruction. During clinical follow-up, some patients report
referred sensation to the shoulder when there is contact with the flap skin island
surface. The authors examine the anatomical origin/characteristics of the supraclavicular
nerves (C3–4) to this flap and its relationship to the flap pedicle and anatomical
boundaries.
Methods
SAI flap harvest and nerve dissection was performed in seven fresh frozen cadavers
(n = 10) using loupe magnification in order to further elucidate the sensory nerve branches
in a typical SAI flap.
Results
Branches of the supraclavicular nerve innervating the SAI flap were found to emerge
from the deep fascia at a separate location from the vascular pedicle with the major
nerve root exiting underneath the sternocleidomastoid muscle near the midpoint of
the muscle belly. The nerve branches proximal to the pedicle with one branch exiting
anterior to the flap and another running axially along the length of the flap. The
majority (9/10) flaps had a major cutaneous nerves located 1–2 cm anterior to the
pedicle. One (1/10) of the flaps had a major cutaneous nerve located 1–2 cm posterior
to the pedicle toward the trapezius muscle. In 3 of the 10 flaps, smaller cutaneous
nerves were also found posterior to the pedicle in a more distal location of the flap.
Conclusions
The supraclavicular nerves innervating the SAI flap are easily identifiable and can
be preserved or ligated, depending on the desired flap function, when present close
to the pedicle. Further clinical investigation is warranted to confirm the potential
benefit of using the SAI flap as a neurotized regional flap for head/neck reconstruction.
Keywords
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Article info
Publication history
Published online: September 19, 2011
Accepted:
August 19,
2011
Received:
January 26,
2011
Identification
Copyright
© 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
