American Association of Plastic Surgeons

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The Superior Deltoid Perforator Flap- Anatomical Understanding And Clinical Application
Richard J. Ross, MBBS, PhD, Eldon Mah, FRACS.
St Vincent's Hospital, Melbourne, Melbourne, Australia.

Purpose
Propeller flaps have become increasingly important in providing a regional flap option in challenging areas. One such area is the supraclavicular fossa-a region with convex curvature and defects often at the extremes of flaps based on thoracic or upper limb vessels. The present study aims to detail the arterial anatomy with a clinical case illustration of the superior deltoid perforator propeller flap, particularly relating to sarcoma reconstruction.
Methods
Twenty fresh cadavers were injected with radiopaque medium prior to dissection of the superior deltoid perforator vessel. Flaps were subjected to plain x-ray plus CT angiography to visualise the arterial system and relation to surrounding muscle and fascia.
Results
All twenty anatomical specimens demonstrated a musculocutaneous perforator of approximately 1mm diameter, emerging through the superior fibres of deltoid. This pierced the deep fascia, ramifying distally before anastomosing with perforators of the posterior circumflex humeral artery, reliably perfusing overlying skin to the level of the deltoid insertion. Understanding of this anatomy lead to application in a 20yo male patient undergoing resection of a soft tissue sarcoma within the supraclavicular fossa (Figure 1).

Conclusion
The supraclavicular fossa is a challenging region for reconstruction. We have described the arterial anatomy and clinical application of a new propeller flap. This is based on a reliable perforator, enabling robust soft tissue coverage, excellent contour match and with no significant donor morbidity.


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