Three- and Four-Dimensional Computed Tomographic Angiography Studies of the Supraclavicular Artery Island Flap

Background: The supraclavicular artery island flap is a useful regional option in head and neck reconstruction. Previous studies have recorded pedicle length, caliber, and ink injection studies of the supraclavicular artery. This study presents a three-and four-dimensional appraisal of the vascular anatomy and perfusion of the supraclavicular artery island flap using a novel computed tomographic technique. Methods: Ten supraclavicular artery island flaps were harvested from fresh cadavers. Each flap was injected with contrast media and subjected to dynamic computed tomographic scanning using a GE Lightspeed 16-slice scanner. Static computed tomographic scanning was also undertaken using a barium-gelatin mixture. Images were viewed using both General Electric and TeraRecon systems, allowing the appreciation of vascular territory (three-dimensional) and analysis of perfusion flow (four-dimensional). Results: The entire skin paddle was perfused in the majority (nine of 10) of flaps. One of the flaps was perfused only 50 percent. In this case, the pedicle artery was found to be much smaller than the other flap pedicles. Direct linking vessels and recurrent flow by means of the subdermal plexus were found to convey the flow of contrast between adjacent perforators. This explains how perfusion extends to adjacent perforators by means of interperforator flow, and how perfusion is maintained all the way to the distal periphery of the flap. Conclusions: Using this imaging technique, the authors elucidated the vascular anatomy of the supraclavicular artery island flap. This study confirms previous clinical findings that the supraclavicular artery island flap is a reliable option and gives surgeons new information for future flap refinement. (Plast. Reconstr. Surg. 125: 525, 2010.)