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J Reconstr Microsurg 2018; 34(07): 499-508
DOI: 10.1055/s-0038-1639577
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Supraclavicular Artery Perforator Flap: A Comparative Study of Imaging Techniques Used in Preoperative Mapping

Hemin Oathman Sheriff
1   Department of Surgery, University of Sulaimani, College of Medicine, Sulaimani, Iraq
2   Department of Burn and Plastic Surgery, Sulaimaniya Teaching Hospital, Sulaimani, Iraq
,
Kawa Abdullah Mahmood
3   Imaging Unit, Department of Surgery, University of Sulaimani, College of Medicine, Sulaimani, Iraq
,
Nzar Hamawandi
1   Department of Surgery, University of Sulaimani, College of Medicine, Sulaimani, Iraq
,
Aram Jamal Mirza
4   Department of Cardiology, Sulaimaniya Teaching Hospital, Interventional Cardiology Center, Sulaimani, Iraq
,
Jawad Hawas
4   Department of Cardiology, Sulaimaniya Teaching Hospital, Interventional Cardiology Center, Sulaimani, Iraq
,
Esther Granell Moreno
5   Department of Neuroradiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalunya, Spain
,
Juan Antonio Clavero
6   Department of Radiology, Creu Blanca Clinic, Barcelona, Spain
,
Christopher Hankins
7   Department of Plastic Surgery, Pearland Premier Plastic Surgery, Pearland
,
Jaume Masia
8   Department of Plastic and Reconstructive Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain
› Author Affiliations
Further Information

Publication History

20 November 2017

11 February 2018

Publication Date:
18 May 2018 (online)

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Correction to:

Erratum: The Supraclavicular Artery Perforator Flap: A Comparative Study of Imaging Techniques Used in Preoperative MappingJ Reconstr Microsurg 2018; 34(07): e1-e1
DOI: 10.1055/s-0039-1683899

Abstract

Background The supraclavicular artery flap is an excellent flap for head and neck reconstruction. The aim of this study is to assess imaging techniques to define the precise vascular boundaries of this flap.

Methods Six imaging techniques were used for supraclavicular artery mapping in 65 cases; handheld Doppler, triplex ultrasound, computed tomography angiography, magnetic resonance angiography, digital subtraction angiography, and indocyanine green angiography. We checked the site of the perforators, the course of a supraclavicular artery, and anatomical mapping of the supraclavicular artery.

Results Handheld Doppler identified perforators' sites in 80% of the cases but showed no results for the course of the vessel. Triplex ultrasound identified the site of perforators in 52.9%, and partial mapping of the course of a supraclavicular artery in 64.7% of the cases. Computerized tomography angiography showed the site of perforators in 60%, and the course of supraclavicular artery completely in 45%, and partially in an additional 30%of the cases examined. Magnetic resonance angiography showed negative results for all parameters. Digital subtraction angiography showed the partial course of a supraclavicular artery in 62.5%, but showed no perforators. Indocyanine green angiography showed the site of perforators in 60% and a partial course of supraclavicular artery distal to perforators in 60%.

Anatomical mapping of the vessel was possible with computerized tomography angiogram completely in 45%, and partially in 30%, and was also possible with indocyanine green angiography partially in 60%.

Conclusion Computerized tomography angiography showed best results in the mapping of the supraclavicular artery, but with an inability to define the perforator perfusion territories, and also with risks of irradiation, while indocyanine green angiography is a good alternative as it could precisely map the superficial course of the artery and angiosomes, with no radiation exposure.

Keywords

imaging - mapping - supraclavicular
 

  • References

  • 1 Sands TT, Martin JB, Simms E, Henderson MM, Friedlander PL, Chiu ES. Supraclavicular artery island flap innervation: anatomical studies and clinical implications. J Plast Reconstr Aesthet Surg 2012; 65 (01) 68-71
    CrossrefPubMedGoogle Scholar
  • 2 Vinh VQ, Van Anh T, Ogawa R, Hyakusoku H. Anatomical and clinical studies of the supraclavicular flap: analysis of 103 flaps used to reconstruct neck scar contractures. Plast Reconstr Surg 2009; 123 (05) 1471-1480
    CrossrefPubMedGoogle Scholar
  • 3 Pallua N, Magnus Noah E. The tunneled supraclavicular island flap: an optimized technique for head and neck reconstruction. Plast Reconstr Surg 2000; 105 (03) 842-851 , discussion 852–854
    CrossrefPubMedGoogle Scholar
  • 4 Alves HR, Ishida LC, Ishida LH. , et al. A clinical experience of the supraclavicular flap used to reconstruct head and neck defects in late-stage cancer patients. J Plast Reconstr Aesthet Surg 2012; 65 (10) 1350-1356
    CrossrefPubMedGoogle Scholar
  • 5 Chan JW, Wong C, Ward K, Saint-Cyr M, Chiu ES. Three- and four-dimensional computed tomographic angiography studies of the supraclavicular artery island flap. Plast Reconstr Surg 2010; 125 (02) 525-531
    CrossrefPubMedGoogle Scholar
  • 6 Kazanjian V, Converse JM. The Surgical Treatment of Facial Injuries. 2nd ed. Baltimore, MA: Williams & Wilkins Company; 1959
    Google Scholar
  • 7 Lamberty BG, Cormack GC. Misconceptions regarding the cervico-humeral flap. Br J Plast Surg 1983; 36 (01) 60-63
    CrossrefPubMedGoogle Scholar
  • 8 Pallua N, Demir E. Postburn head and neck reconstruction in children with the fasciocutaneous supraclavicular artery island flap. Ann Plast Surg 2008; 60 (03) 276-282
    CrossrefPubMedGoogle Scholar
  • 9 Pallua N, Machens HG, Rennekampff O, Becker M, Berger A. The fasciocutaneous supraclavicular artery island flap for releasing postburn mentosternal contractures. Plast Reconstr Surg 1997; 99 (07) 1878-1884 , discussion 1885–1886
    CrossrefPubMedGoogle Scholar
  • 10 Pallua N, von Heimburg D. Pre-expanded ultra-thin supraclavicular flaps for (full-) face reconstruction with reduced donor-site morbidity and without the need for microsurgery. Plast Reconstr Surg 2005; 115 (07) 1837-1844 , discussion 1845–1847
    CrossrefPubMedGoogle Scholar
  • 11 Di Benedetto G, Aquinati A, Pierangeli M, Scalise A, Bertani A. From the “charretera” to the supraclavicular fascial island flap: revisitation and further evolution of a controversial flap. Plast Reconstr Surg 2005; 115 (01) 70-76
    PubMedGoogle Scholar
  • 12 Chiu ES, Liu PH, Baratelli R, Lee MY, Chaffin AE, Friedlander PL. Circumferential pharyngoesophageal reconstruction with a supraclavicular artery island flap. Plast Reconstr Surg 2010; 125 (01) 161-166
    CrossrefPubMedGoogle Scholar
  • 13 Kadakia S, Agarwal J, Mourad M, Ashai S, Lee T, Ducic Y. Supraclavicular flap reconstruction of cutaneous defects has lower complication rate than mucosal defects. J Reconstr Microsurg 2017; 33 (04) 275-280
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Razdan SN, Albornoz CR, Ro T. , et al. Safety of the supraclavicular artery island flap in the setting of neck dissection and radiation therapy. J Reconstr Microsurg 2015; 31 (05) 378-383
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Busche MN, Pallua N. Evolution in flap design: from the supraclavicular artery island flap to the anterior supraclavicular artery perforator flap. J Reconstr Microsurg 2016; 32 (03) 242-244
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Aoyagi F, Fujino T, Ohshiro T. Detection of small vessels for microsurgery by a Doppler flowmeter. Plast Reconstr Surg 1975; 55 (03) 372-373
    CrossrefPubMedGoogle Scholar
  • 17 Smit JM, Klein S, Werker PM. An overview of methods for vascular mapping in the planning of free flaps. J Plast Reconstr Aesthet Surg 2010; 63 (09) e674-e682
    CrossrefPubMedGoogle Scholar
  • 18 Gerlock Jr AJ, Perry PE, Goncharenko V, Franklin JD. Evaluation of the dorsalis pedis free flap donor site by angiography. Radiology 1979; 130 (02) 341-343
    CrossrefPubMedGoogle Scholar
  • 19 May Jr JW, Athanasoulis CA, Donelan MB. Preoperative magnification angiography of donor and recipient sites for clinical free transfer of flaps or digits. Plast Reconstr Surg 1979; 64 (04) 483-490
    CrossrefPubMedGoogle Scholar
  • 20 Hutchinson DT. Color duplex imaging. Applications to upper-extremity and microvascular surgery. Hand Clin 1993; 9 (01) 47-57
    PubMedGoogle Scholar
  • 21 Masia J, Clavero JA, Larrañaga JR, Alomar X, Pons G, Serret P. Multidetector-row computed tomography in the planning of abdominal perforator flaps. J Plast Reconstr Aesthet Surg 2006; 59 (06) 594-599
    CrossrefPubMedGoogle Scholar
  • 22 Fukaya E, Grossman RF, Saloner D, Leon P, Nozaki M, Mathes SJ. Magnetic resonance angiography for free fibula flap transfer. J Reconstr Microsurg 2007; 23 (04) 205-211
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Smit JM, Dimopoulou A, Liss AG. , et al. Preoperative CT angiography reduces surgery time in perforator flap reconstruction. J Plast Reconstr Aesthet Surg 2009; 62 (09) 1112-1117
    CrossrefPubMedGoogle Scholar
  • 24 Matsui A, Lee BT, Winer JH, Kianzad V, Frangioni JV. Image-guided perforator flap design using invisible near-infrared light and validation with x-ray angiography. Ann Plast Surg 2009; 63 (03) 327-330
    CrossrefPubMedGoogle Scholar
  • 25 Su W, Lu L, Lazzeri D. , et al. Contrast-enhanced ultrasound combined with three-dimensional reconstruction in preoperative perforator flap planning. Plast Reconstr Surg 2013; 131 (01) 80-93
    PubMedGoogle Scholar
  • 26 Khan UD, Miller JG. Reliability of handheld Doppler in planning local perforator-based flaps for extremities. Aesthetic Plast Surg 2007; 31 (05) 521-525
    CrossrefPubMedGoogle Scholar
  • 27 Yu P, Youssef A. Efficacy of the handheld Doppler in preoperative identification of the cutaneous perforators in the anterolateral thigh flap. Plast Reconstr Surg 2006; 118 (04) 928-933 , discussion 934–935
    CrossrefPubMedGoogle Scholar
  • 28 Mun GH, Jeon BJ. An efficient method to increase specificity of acoustic Doppler sonography for planning a perforator flap: perforator compression test. Plast Reconstr Surg 2006; 118 (01) 296-297
    CrossrefPubMedGoogle Scholar
  • 29 Alonso-Burgos A, García-Tutor E, Bastarrika G, Benito A, Domínguez PD, Zubieta JL. Preoperative planning of DIEP and SGAP flaps: preliminary experience with magnetic resonance angiography using 3-tesla equipment and blood-pool contrast medium. J Plast Reconstr Aesthet Surg 2010; 63 (02) 298-304
    CrossrefPubMedGoogle Scholar
  • 30 Ogawa R, Murakami M, Vinh VQ, Hyakusoku H. 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. Plast Reconstr Surg 2006; 118 (01) 95-101
    PubMedGoogle Scholar
  • 31 Rozen WM, Garcia-Tutor E, Alonso-Burgos A. , et al. Planning and optimising DIEP flaps with virtual surgery: the Navarra experience. J Plast Reconstr Aesthet Surg 2010; 63 (02) 289-297
    CrossrefPubMedGoogle Scholar
  • 32 Mathes DW, Neligan PC. Current techniques in preoperative imaging for abdomen-based perforator flap microsurgical breast reconstruction. J Reconstr Microsurg 2010; 26 (01) 3-10
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Pacifico MD, See MS, Cavale N. , et al. Preoperative planning for DIEP breast reconstruction: early experience of the use of computerised tomography angiography with VoNavix 3D software for perforator navigation. J Plast Reconstr Aesthet Surg 2009; 62 (11) 1464-1469
    CrossrefPubMedGoogle Scholar
  • 34 Rozen WM, Ashton MW, Grinsell D, Stella DL, Phillips TJ, Taylor GI. Establishing the case for CT angiography in the preoperative imaging of abdominal wall perforators. Microsurgery 2008; 28 (05) 306-313
    CrossrefPubMedGoogle Scholar
  • 35 Rozen WM, Ashton MW. The “limited rectus sheath incisions” technique for DIEP flaps using preoperative CT angiography. Microsurgery 2009; 29 (07) 525-528
    CrossrefPubMedGoogle Scholar
  • 36 Ribuffo D, Atzeni M, Saba L, Milia A, Guerra M, Mallarini G. Angio computed tomography preoperative evaluation for anterolateral thigh flap harvesting. Ann Plast Surg 2009; 62 (04) 368-371
    CrossrefPubMedGoogle Scholar
  • 37 Rozen WM, Phillips TJ, Ashton MW, Stella DL, Gibson RN, Taylor GI. Preoperative imaging for DIEA perforator flaps: a comparative study of computed tomographic angiography and Doppler ultrasound. Plast Reconstr Surg 2008; 121 (01) 9-16
    CrossrefPubMedGoogle Scholar
  • 38 Singh J, Daftary A. Iodinated contrast media and their adverse reactions. J Nucl Med Technol 2008; 36 (02) 69-74 , quiz 76–77
    CrossrefPubMedGoogle Scholar
  • 39 Chernyak V, Rozenblit AM, Greenspun DT. , et al. Breast reconstruction with deep inferior epigastric artery perforator flap: 3.0-T gadolinium-enhanced MR imaging for preoperative localization of abdominal wall perforators. Radiology 2009; 250 (02) 417-424
    CrossrefPubMedGoogle Scholar
  • 40 Rozen WM, Stella DL, Phillips TJ, Ashton MW, Corlett RJ, Taylor GI. Magnetic resonance angiography in the preoperative planning of DIEA perforator flaps. Plast Reconstr Surg 2008; 122 (06) 222e-223e
    CrossrefPubMedGoogle Scholar
  • 41 Kelly AM, Cronin P, Hussain HK, Londy FJ, Chepeha DB, Carlos RC. Preoperative MR angiography in free fibula flap transfer for head and neck cancer: clinical application and influence on surgical decision making. AJR Am J Roentgenol 2007; 188 (01) 268-274
    CrossrefPubMedGoogle Scholar
  • 42 Lohan DG, Tomasian A, Krishnam M, Jonnala P, Blackwell KE, Finn JP. MR angiography of lower extremities at 3 T: presurgical planning of fibular free flap transfer for facial reconstruction. AJR Am J Roentgenol 2008; 190 (03) 770-776
    CrossrefPubMedGoogle Scholar
  • 43 Seres L, Csaszar J, Voros E, Borbely L. Donor site angiography before mandibular reconstruction with fibula free flap. J Craniofac Surg 2001; 12 (06) 608-613
    CrossrefPubMedGoogle Scholar
  • 44 Tan O, Kantarci M, Parmaksizoglu D, Uyanik U, Durur I. Determination of the recipient vessels in the head and neck using multislice spiral computed tomography angiography before free flap surgery: a preliminary study. J Craniofac Surg 2007; 18 (06) 1284-1289
    CrossrefPubMedGoogle Scholar
  • 45 Herz D, DaJusta D, Ching C, McLeod D. Segmental arterial mapping during pediatric robot-assisted laparoscopic heminephrectomy: a descriptive series. J Pediatr Urol 2016; 12 (04) 266.e1-266.e6
    CrossrefPubMedGoogle Scholar
  • 46 Namikawa T, Sato T, Hanazaki K. Recent advances in near-infrared fluorescence-guided imaging surgery using indocyanine green. Surg Today 2015; 45 (12) 1467-1474
    CrossrefPubMedGoogle Scholar