Evolution in Flap Design: From the Supraclavicular Artery Island Flap to the Anterior Supraclavicular Artery Perforator Flap

We read with interest the article “Case Report of a Supraclavicular Artery Island Flap for Reconstruction of a Nonhealing Cervical Spine Wound” by Razdan et al.[1] In this article, the authors present a very interesting and novel application of the supraclavicular artery island flap, also known as supraclavicular island flap or supraclavicular artery perforator (SAP) flap for closure of posterior cervical spine defects.[1] We appreciate the worldwide increasing interest in the SAP flap and congratulate the authors on the first published successful treatment of a posterior cervical spine defect with a SAP flap. In their article, the authors discuss the advantages of the SAP flap (thin skin paddle, short harvest time, preservation of regional muscle units, and good color match of the skin island) in comparison to other flaps traditionally used to cover posterior spine defects, such as paraspinous, latissimus dorsi, and trapezius flaps.[1] In addition, the authors give an overview of the use of the SAP flap for reconstruction of head and neck defects in the literature, such as pharynx,[2] [3] [4] parotid,[2] [3] and skin defects.[4]

While most citations in the article are correct, Razdan et al refer to a publication by Pallua et al from 2010, as a publication about the use of the SAP flap for esophagocutaneous fistulas.[5] However, the authors are mistaken, since the article by Pallua et al from 2010 introduced the SAP flap as an option for closure of tracheocutaneous fistulas and not for esophagocutaneous fistulas.[5] In this article, Pallua et al also proposed a defect classification and a treatment algorithm using the tunneled supraclavicular artery island flap for functional and esthetic reconstruction.[5]

Additionally, the reviewed literature regarding the SAP flap in the article by Razdan et al is missing an important publication by Pallua et al from 1997, describing the SAP flap for the first time: “The Fasciocutaneous Supraclavicular Artery Island Flap for Releasing Postburn Mentosternal Contractures.”[6]

Since Razdan et al discuss the use of the SAP flap not only for posterior spine defects but also for head and neck reconstruction, it could be of interest for the reader to mention the anterior supraclavicular artery perforator (a-SAP) flap, primarily described by Pallua et al in 2013 as a similar treatment option.[7] The a-SAP flap is an improvement of the SAP flap, using a separate anterior supraclavicular pedicle, placing the skin island into the deltoideopectoral fossa.[7] Compared with the SAP flap, the a-SAP flap is even thinner and has an even better color match to the face.[7]

• References

• 1 Razdan SN, Ro T, Albornoz CR, Bilsky MH, Matros E. Case report of a supraclavicular artery island flap for reconstruction of a nonhealing cervical spine wound. J Reconstr Microsurg 2015; 31: 236-238
• 2 Chiu ES, Liu PH, Friedlander PL. Supraclavicular artery island flap for head and neck oncologic reconstruction: indications, complications, and outcomes. Plast Reconstr Surg 2009; 124 (1) 115-123
• 3 Granzow JW, Suliman A, Roostaeian J, Perry A, Boyd JB. Supraclavicular artery island flap (SCAIF) vs free fasciocutaneous flaps for head and neck reconstruction. Otolaryngol Head Neck Surg 2013; 148 (6) 941-948
• 4 Kokot N, Mazhar K, Reder LS, Peng GL, Sinha UK. The supraclavicular artery island flap in head and neck reconstruction: applications and limitations. JAMA Otolaryngol Head Neck Surg 2013; 139 (11) 1247-1255
• 5 Pallua N, Wolter TP. Defect classification and reconstruction algorithm for patients with tracheostomy using the tunneled supraclavicular artery island flap. Langenbecks Arch Surg 2010; 395 (8) 1115-1119
• 6 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 (7) 1878-1884
• 7 Pallua N, Wolters TP. Moving forwards: The anterior supraclavicular artery perforator (a-SAP) flap. A new pedicled or free perforator flap based on the anterior supraclavicular vessels. J Plast Reconstr Aesthet Surg 2013; 66 (4) 489-496