Supraclavicular fasciocutaneous flap for head and neck reconstructive surgery


  • I. P. Fedzhaha Podilsky Regional Center Of Oncology, innytsia, Ukraine,
  • O. V. Kravets National Cancer Institute, Kyiv, Ukraine,
  • V. A. Shamrai Podilsky Regional Center of Oncology, Vinnytsia, Ukraine,
  • V. I. Pivtorak National Pirogov Memorial Medical University, Vinnytsia, Ukraine,
  • O. P. Fedzhaha National Pirogov Memorial Medical University, Vinnytsia, Ukraine,
  • I. M. Plakhotniuk National Pirogov Memorial Medical University, Vinnytsia, Ukraine,
  • A. O. Kovalchuk Ivan Horbachevsky Ternopil State Medical University, Ukraine,



supraclavicular artery, surgical flaps, head and neck neoplasms, soft tissue injuries


The purpose of the work is to present modern data on the plastic closure of head and neck defects after malignant tumors removing and in burn injury of this region using supraclavicular flap in the professional literature. This article presents the review and comparison results of modern researches on topographical features of transverse cervical artery and supraclavicular artery, as well as these vessels peak blood flow velocity for the purpose of optimal blood supply preservation in the surgically formed supraclavicular artery flaps. The review describes the study results of topographical features of the cutaneous cervical plexus nerves, consideration of which makes it possible to save or not to save the skin sensibility of flap depending on the surgeon’s goal. The review addresses the analysis results of complications following postoperative defects of soft tissue, skin and mucous membranes surgical closure after head and neck malignant neoplasms removal with a detailed description of the complications nature, localization and size of defects, relation to previous radiotherapy. Our own experience results of reconstruction with supraclavicular flap for head and neck oncosurgery in 77 patients are also presented.

The review provides the results of comparative studies on perforating supraclavicular fasciocutaneous flap as well as the microvascular forearm free flap use, with the analysis of total operative time and duration of flap division, the need to stay in an intensive care unit, postoperative morbidity, long-term functional results and the total cost of treatment. There are the results of the supraclavicular flap use in head and neck burn wounds closure with the analysis of complications and long-term functional and cosmetic outcomes. Based on the large clinical experience (a total of 316 patients) obtained in 12 clinics over a period of more than 10 years, it can be concluded that the supraclavicular fasciocutaneous flap has a number of advantages and is recommended for widespread use in the plastic closure of head and neck defects after burn injury and malignant tumors



White-Gilbertson, S., Nelson, S., Zhan, K., Xiao, C., Cope, L. & Day, T. (2015) Analysis of the National Cancer Data Base to Describe Treatment Trends in Stage IV Oral Cavity and Pharyngeal Cancers in the United States, 1998–2012. J Registry Manag., 42(4), 146–151.

Osborn, H. A., Rathi, V. K., Tjoa, T., Goyal, N., Yarlagadda, B. B., Rich, D. L., et al. (2018) Risk factors for thirty-day readmission following flap reconstruction of oncologic defects of the head and neck. Laryngoscope, 128(2), 343–349. doi: 10.1002/lary.26726.

Liu, W. W., Zhang, C. Y., Li, J. Y., Zhang, M. F. & Guo, Z. M. (2017) A novel classification system for the evaluation and reconstruction of oral defects following oncological surgery. Oncol Lett., 14(6), 7049–7054. doi: 10.3892/ol.2017.7139.

Hunt, J. P., & Buchmann, L. O. (2014) The supraclavicular artery flap for lateral skull and scalp defects: effective and efficient alternative to free tissue transfer. J Neurol Surg Rep., 75(1), e5–e10. doi: 10.1055/s-0033-1358376.

Nthumba, P. M. (2012) The supraclavicular artery flap: a versatile flap for neck and orofacial reconstruction. J Oral Maxillofac Surg., 70(8), 1997–2004. doi: 10.1016/j.joms.2011.08.043.

Chen, W. L., Zhang, D. M., Yang, Z. H., Huang, Z. Q., Wang, J. G., Zhang, B., & Li, J. S. (2010) Extended supraclavicular fasciocutaneous island flap based on the transverse cervical artery for head and neck reconstruction after cancer ablation. J Oral Maxillofac Surg., 68(10), 2422–2430. doi: 10.1016/j.joms.2010.01.015.

Lee, D. M., Bae, Y. C., Nam, S. B., Bae, S. H. & Choi, J. S. (2017) Reconstruction of Large Facial Defects via Excision of Skin Cancer Using Two or More Regional Flaps. Arch Plast Surg., 44(4), 319–323. doi: 10.5999/aps.2017.44.4.319.

Epps, M. T., Cannon, C. L., Wright, M. J., Chaffin, A. E., Newsome, R. E., Friedlander, P. L., & Chiu, E. S. (2011) Aesthetic restoration of parotidectomy contour deformity using the supraclavicular artery island flap. Plast Reconstr Surg., 127(5), 1925–31. doi: 10.1097/PRS.0b013e31820cf40a.

Liu, F. Y., Xu, Z. F., Li, P., Sun, C. F., Li, R. W., Ge, S. F., et al. (2011) The versatile application of cervicofacial and cervicothoracic rotation flaps in head and neck surgery. World J Surg Oncol., 9, 135. doi: 10.1186/1477-7819-9-135.

Telang, P., Jagannathan, M., & Devale, M. (2009) A study of the use of the supraclavicular artery flap for resurfacing of head, neck, and upper torso defects. Indian J Plast Surg., 42(1), 4–12. doi: 10.4103/0970-0358.53005.

Boyette, J. R., & Vural, E. (2011) Cervicofacial advancement-rotation flap in midface reconstruction: forward or reverse? Otolaryngol Head Neck Surg., 144(2), 196–200. doi: 10.1177/0194599810391391.

Hartman, E. H., Van Damme, P. A., & Suominen, S. H. (2006) The use of the pedicled supraclavicular flap in noma reconstructive surgery. Plast Reconstr Surg., 118(1), 270–1. doi: 10.1097/01.prs.0000222218.88688.37.

Pointer, D. T. Jr., Friedlander, P. L., Amedee, R. G., Liu, P. H., & Chiu, E. S. (2010) Infratemporal fossa reconstruction following total auriculectomy: an alternative flap option. J Plast Reconstr Aesthet Surg. 63(8), e615–e618. doi: 10.1016/j.bjps.2010.01.027.

Mathes, S., & Vascones, L. (1978) The cervicohumeral flap. Plas. Reconstr.Surg. 61(1), 7–12. doi: 10.1097/00006534-197801000-00002.

Blevins, P., & Luce, E. (1980) Limitations of the cervicohumeral flap in head and neck reconstruction. Plast Reconstr Surg., 66(2), 220–224. doi: 10.1097/00006534-198008000-00009.

Lamberty, B. G., & Cormack, G. C. (1983) Misconceptions regarding the cervico-humeral flap. Br J Plast Surg., 36(1), 60–63. doi:

Lamberty, B. G. (1979) The supra-clavicular axial patterned flap. Br J Plast Surg., 32(3), 207–212. doi: 10.1016/0007-1226(79)90033-X.

Pallua, N., & Magnus, N. E. (2000) The tunneled supraclavicular island flap: an optimized technique for head and neck reconstruction. Plast Reconstr Surg., 105(3), 842–851. doi: 10.1097/00006534-200003000-00003.•

Anand, A. G., Tran, E. J., Hasney, C. P., Friedlander, P. L., & Chiu, E. S. (2012) Oropharyngeal reconstruction using the supraclavicular artery island flap: a new flap alternative. Plast Reconstr Surg., 129(2), 438–441. doi: 10.1097/PRS.0b013e31823aebce.

Teymoortash, A., Mandapathil, M., & Hoch, S. (2014) Indications for reconstruction of mucosal defects in oropharyngeal cancer using a supraclavicular island flap. Int J Oral Maxillofac Surg., 43(9), 1054–1058. doi: 10.1016/j.ijom.2014.04.012.

Chiu, E. S., Liu, P. H., & Friedlander, P. L. (2009) Supraclavicular artery island flap for head and neck oncologic reconstruction: indications, complications, and outcomes. Plast Reconstr Surg., 124(1), 115–123. doi: 10.1097/PRS.0b013e3181aa0e5d.

Alves, H. R., Ishida, L. C., Ishida, L. H., Besteiro, J. M., Gemperli, R., Faria, J. C., & Ferreira, M. C. (2012) A clinical experience of the supraclavicular flap used to reconstruct head and neck defects in late-stage cancer patients. J Plast Reconstr Aesthet Surg., 65(10), 1350–1356. doi: 10.1016/j.bjps.2012.04.050.

Herr, M. W., Emerick, K. S., & Deschler, D. G. (2014) The supraclavicular artery flap for head and neck reconstruction. JAMA Facial Plast Surg., 16(2), 127–32. doi: 10.1001/jamafacial.2013.2170.

Levy, J. M., Eko, F. N., Hilaire, H. S., Friedlander, P. L., Melgar, M. A., & Chiu, E. S. (2011) Posterolateral skull base reconstruction using the supraclavicular artery island flap. J Craniofac Surg., 22(5), 1751–1754. doi: 10.1097/SCS.0b013e31822e62e9.

Trautman, J., Gore, S., Potter, M., Clark, J., Hyam, D., Tan, N. C., et al. (2018) Supraclavicular flap repair in the free flap era. ANZ J Surg., 88(6), 540–546. doi: 10.1111/ans.14263.

Ismail, H., & Elshobaky, A. (2016) Supraclavicular artery perforator flap in management of post-burn neck reconstruction: clinical experience. Ann Burns Fire Disasters., 29(3), 209–214.

Adams, A. S., Wright, M. J., Johnston S., Tandon, R., Gupta, N., Ward, K., et al. (2012) The use of multislice CT angiography preoperative study for supraclavicular artery island flap harvesting. Ann Plast Surg., 69(3), 312–315. doi: 10.1097/SAP.0b013e31822afaba.

Uysal, C. A., Ogawa, R., Vinh, V. Q., Mizuno, H., & Hyakusoku, H. (2009) Vascular anatomy of the supraclavicular area revisited. Plast Reconstr Surg., 123(6), 1880–1881. doi: 10.1097/PRS.0b013e3181a65bfe.

Austen, W. G., Parrett, B. M., Taghinia, A., Wolfort, S. F., & Upton, J. (2009) The subcutaneous cervicofacial flap revisited. Ann Plast Surg., 62(2), 149–153. doi: 10.1097/SAP.0b013e31819354f5.

Cordova, A., D'Arpa, S., Pirrello, R., Brenner, E., Jeschke, J., & Moschella, F. (2009) Anatomic study on the transverse cervical vessels perforators in the lateral triangle of the neck and harvest of a new flap: The free supraclavicular transverse cervical artery perforator flap. Surg Radiol Anat., 31(2), 93–100. doi: 10.1007/s00276-008-0410-x.

Cordova, R., Pirrello, S., D'Arpa, J., Jeschke, E., Brenner, F., & Moschella, F. (2008) MoschellaVascular anatomy of the supraclavicular area revisited: feasibility of the free supraclavicular perforator flap. Plast Reconstr Surg., 122(5), 1399–1409. doi: 10.1097/PRS.0b013e3181891651.

Gao, Y., Yuan, Y., Li, H., Gu, B., Xie, F., Herrler, T., et al. (2016) Preoperative Imaging for Thoracic Branch of Supraclavicular Artery Flap: A Comparative Study of Contrast-Enhanced Ultrasound With Three-Dimensional Reconstruction and Color Duplex Ultrasound. Ann Plast Surg., 77(2), 201–205. doi: 10.1097/SAP.0000000000000601.

Sands, T. T., Martin, J. B., Simms, E., Henderson, M. M, Friedlander, P. L. & Chiu, E. S. (2012) Supraclavicular artery island flap innervation: anatomical studies and clinical implications. J Plast Reconstr Aesthet Surg., 65(1), 68–71. doi: 10.1016/j.bjps.2011.08.026.

Vinh, V., Van Anh, T., Ogawa, R., & Hyakusoku, H. (2009) Anatomical and Clinical Studies of the Supraclavicular Flap: Analysis of 103 Flaps Used to Reconstruct Neck Scar Contractures. Plast. Reconstr. Surg. 123(5), 1471–1480. doi: 10.1097/PRS.0b013e3181a205ba.

Tafur, V., Magden, O., Edizer, M., & Menderes, A. (2010) Supraclavicular artery flap. J Craniofac Surg., 21, 1938–1940.

Bruchhage, K. L., Leichtle, A. & Wollenberg, B. (2017) Reconstruction with supraclavicular island flaps : An option in oncological treatment of head and neck carcinomas. HNO., 65(1), 53–57. doi: 10.1007/s00106-016-0211-1.

Di Benedetto, G., Aquinati, A., Pierangeli, M., Scalise, A., & Bertani, A. (2005) From the “charretera” to the supraclavicular fascial island flap: revisitation and further evolution of a controversial flap. Plast Reconstr Surg., 115(1), 70–76. doi: 10.1097/01.PRS.0000146033.73773.D1.

Kokot, N., Mazhar, K., Reder, L. S., Peng, G. L. & Sinha, U. K. (2014) Use of the supraclavicular artery island flap for reconstruction of cervicofacial defects. Otolaryngol Head Neck Surg., 150(2), 222–228. doi: 10.1177/0194599813514205.

Sandu, K., Monnier, P. & Pasche, P. (2012) Supraclavicular flap in head and neck reconstruction: experience in 50 consecutive patients. Eur Arch Otorhinolaryngol, 269(4), 1261–1267. doi: 10.1007/s00405-011-1754-0.

Padiyar, B. V., Azeem, S. M., Sagayaraj, M. A., & Merchant, S. (2018) Usefulness of supraclavicular flap in reconstruction following resection of oral cancer. World Journal of Otorhinolaryngology – Head and Neck Surgery Available online, 4(2), 148–152. doi:

Giordano, L., Di Santo, D., Occhini, A., Galli, A., Bertino, G., Benazzo, M. & Bussi, M. (2016) Supraclavicular artery island flap (SCAIF): a rising opportunity for head and neck reconstruction. Eur Arch Otorhinolaryngol., 273(12), 4403–4412. doi: 10.1007/s00405-016-4092-4.

Goyal, N., Emerick, K. S., Deschler, D. G., Lin, D. T., Yarlagadda, B. B., Rich, D. L. & Durand, M. L. (2016) Risk factors for surgical site infection after supraclavicular flap reconstruction in patients undergoing major head and neck surgery. Head Neck., 38(11), 1615–1620. doi: 10.1002/hed.24480.

Kadakia, S., Agarwal, J., Mourad, M., Ashai, S., Lee, T. & Ducic, Y. (2017) Supraclavicular Flap Reconstruction of Cutaneous Defects Has Lower Complication Rate than Mucosal Defects. J Reconstr Microsurg., 33(4), 275–280. doi: 10.1055/s-0036-1597718.

Sweeny, L., Rosenthal, E. L., Light, T., Grayson, J., Petrisor, D., Troob, S. H., Greene, B. J., Carroll, W. R. & Wax, M. K. (2017) Effect of Overlapping Operations on Outcomes in Microvascular Reconstructions of the Head and Neck. Otolaryngol Head Neck Surg., 156(4), 627–635. doi: 10.1177/0194599817691746.

Zhang, S., Chen, W., Cao, G. & Dong, Z. (2015) Pedicled Supraclavicular Artery Island Flap Versus Free Radial Forearm Flap for Tongue Reconstruction Following Hemiglossectomy. J Craniofac Surg. Sep, 26(6), 527–530. doi: 10.1097/SCS.0000000000002031.

González-García, J. A., Chiesa-Estomba, C. M., Sistiaga, J. A., Larruscain, E., Álvarez, L. & Altuna, X. (2017) Utility and versatility of the supraclavicular artery island flap in head and neck reconstruction. Acta Otorrinolaringologica Espanola., 69(1), 8–12. doi: 10.1016/j.otorri.2017.03.004.

Welz, C., Canis, M., Schwenk-Zieger, S., Spiegel, J. L., Weiss, B. G. & Pilavakis, Y. (2017) Oral Cancer Reconstruction Using the Supraclavicular Artery Island Flap: Comparison to Free Radial Forearm Flap. J Oral Maxillofac Surg.,75(10), 2261–2269. doi: 10.1016/j.joms.2017.02.017.

Granzow, J. W., Suliman, A., Roostaeian, J., Perry, A. & Boyd, J. B. (2013) Supraclavicular artery island flap (SCAIF) vs free fasciocutaneous flaps for head and neck reconstruction. Otolaryngol Head Neck Surg., 148(6), 941–948. doi: 10.1177/0194599813476670.

Kokot, N., Mazhar, K., Reder, L. S., Peng, G. L., & Sinha, U. K. (2013) The supraclavicular artery island flap in head and neck reconstruction: applications and limitations. JAMA Otolaryngol Head Neck Surg., 139(11), 1247–1255. doi: 10.1001/jamaoto.2013.5057.

Pallua, N. & Kim, B. S. (2017) Pre-expanded Supraclavicular Artery Perforator Flap. Clin Plast Surg., 44(1), 49–63. doi: 10.1016/j.cps.2016.08.005.

Song, B., Chen, J., Ma, X., Li, Y., Zhang, J. & Guo, S. (2016) The pre-expanded subclavicular island flap: A new tool for facial reconstruction. J Plast Reconstr Aesthet Surg, 69(12), 1653–1661. doi: 10.1016/j.bjps.2016.09.001.

Ramos, R. R. & Ferreira, L. M. (2017) Sub fascial flap based on the supraclavicular artery in reconstruction of neck burn contractures. Burns., 43(5), e1–e4. doi: 10.1016/j.burns.2017.03.031.

How to Cite

Fedzhaha IP, Kravets OV, Shamrai VA, Pivtorak VI, Fedzhaha OP, Plakhotniuk IM, Kovalchuk AO. Supraclavicular fasciocutaneous flap for head and neck reconstructive surgery. Zaporozhye Medical Journal [Internet]. 2019Feb.8 [cited 2024Jul.20];(1). Available from: