The Supraclavicular Island Flap for Neck Reconstruction: Report of Two Cases

For the reconstructive procedures in the head and neck region, the methods range from local, mostly myocutaneous, flaps and skin grafts to free flaps. To ensure a satisfactory functional and aesthetic result, good texture and color of the flap are essential. Especially in the face, surgical reconstruction has to take account of the aesthetic units and a thin flap to enable mimic function. Moreover, the donor defect needs to be reduced without functional or aesthetic impairment. As a basic concept, first formulated by Gillies in 1920, the more adjacent the donor site is, the better the skin will match the recipient site. To achieve these goals, a thin reliable flap, harvested close to the face and neck region with good skin texture match, and a hairless sensated skin surface are needed. We have found that the shoulder is a region providing an optimum skin texture match to the neck. In this article, fasciocutaneous island flap, nourished by the supraclavicular artery, was used through the subcutaneous tunnel for the defect of neck. We used this flap in 2 patients who have supraglottic squamous cell carcinoma and lateral neck soft tissue defect after cellulitis. The functional result was satisfactory and the tunneling maneuver significantly improves the donor site aesthetically by reducing the scar. So we report these present clinical two cases of the flap in reconstructive procedures of neck.

Repositioning of Pacemaker Generator due to Therapeutic Radiation: A Tunneling Method

Therapeutic ionizing radiation can damage the permanent pacemaker. Reimplantation of pacemaker should be considered when the pacemaker site is included in the radiation field. We report a case of successful repositioning of preexisting pacemaker generator and leads with subcutaneous tunneling method across the sternum instead of insertion of new leads in a female patient with breast cancer who had DDD pacemaker.