supraclavicular flap: Definition, Uses, and Clinical Overview

Definition (What it is) of supraclavicular flap

A supraclavicular flap is a piece of skin and soft tissue taken from the area just above the collarbone (clavicle) and moved to repair another area.
It is most often a reconstructive technique used for head and neck defects, including skin, lining, or soft-tissue coverage.
It stays connected to its original blood supply in many cases, which helps the transferred tissue survive.
It may also be used in selected cosmetic or scar-related situations where similar skin coverage is needed.

Why supraclavicular flap used (Purpose / benefits)

The supraclavicular flap is used to replace missing or damaged tissue in a way that aims to restore both function (such as coverage, protection, and mobility of nearby structures) and appearance (such as color and texture match).

In practical terms, clinicians may choose this flap when they need a reliable, thin-to-moderate thickness tissue that can reach the face, neck, or upper chest region without requiring a distant donor site. Because the tissue comes from the shoulder/neck region, it can sometimes provide a closer skin tone and texture match than tissue taken from the leg or abdomen, depending on the individual.

Potential benefits, which vary by clinician and case, may include:

• Coverage of complex wounds where skin grafts alone may not be durable enough (for example, exposed hardware or previously irradiated tissue).
• Reconstruction after tumor removal, trauma, or scarring that creates a defect requiring more than simple closure.
• Contour restoration in areas where missing soft tissue would otherwise create a visible depression or tightness.
• Relatively straightforward positioning for head and neck reconstruction compared with some larger muscle flaps, in appropriately selected cases.

This is a surgical reconstruction technique rather than a cosmetic “refresh” procedure. When used in aesthetic-adjacent contexts (such as scar release or resurfacing), the goal is generally still reconstructive: improving skin quality, movement, and surface appearance rather than creating a purely elective enhancement.

Indications (When clinicians use it)

Clinicians may consider a supraclavicular flap for situations such as:

• Skin and soft-tissue defects of the neck after cancer surgery or trauma
• Coverage needs in parts of the face (selected cheek, jawline, or lower face regions) depending on defect location and reach
• Reconstruction of head and neck lining or surface in selected cases (varies by defect and surgeon preference)
• Post-burn scar contracture release in the neck region when additional pliable skin is needed
• Salvage or revision of wounds with poor local tissue quality, including previously operated areas (case-dependent)
• Coverage of exposed structures (for example, tendon, cartilage, or hardware) where a skin graft may be insufficient (case-dependent)
• Selected tracheostoma or anterior neck soft-tissue coverage needs, depending on anatomy and defect

Contraindications / when it’s NOT ideal

A supraclavicular flap may be less suitable, or used with extra caution, in situations such as:

• Compromised blood supply in the donor area (for example, significant scarring, prior surgery, or vessel injury that may affect flap perfusion)
• Severe tissue damage at the donor site from burns, infection, or extensive prior procedures
• Large or complex defects that exceed the likely size, thickness, or reach of the flap, where a free flap or different regional flap may be more appropriate
• Need for substantial bulk (volume) when the supraclavicular tissue is too thin for the reconstructive requirement
• Situations where the required movement path would create excessive tension or kinking risk (surgeon-dependent)
• Patient factors that can increase surgical risk or impair wound healing (examples can include uncontrolled systemic illness or active smoking), noting that suitability varies by clinician and case
• When donor-site scarring in a visible area is not acceptable to the patient’s goals and alternatives can meet reconstruction needs

Contraindications are often relative rather than absolute in reconstructive surgery. Prior radiation therapy, for example, may influence planning and risk, but does not automatically rule out any single technique; the decision typically depends on tissue condition and the reconstructive plan.

How supraclavicular flap works (Technique / mechanism)

The supraclavicular flap is a surgical tissue-transfer technique. It is not minimally invasive, and it does not rely on devices like lasers, radiofrequency, or injectables as the primary mechanism.

General approach

• A section of skin and underlying tissue is designed over the supraclavicular region (above the clavicle, near the shoulder/neck junction).
• The flap is elevated (lifted) while preserving its blood supply, commonly as a pedicled flap (meaning it stays attached to its original vessels).
• The tissue is then rotated, advanced, or tunneled to the recipient site to cover a defect or resurface an area.

Primary mechanism

The primary mechanism is reconstruction by repositioning living tissue:

• Restore coverage: replacing missing skin/soft tissue to protect underlying structures.
• Resurface: providing new skin to an area that cannot be closed directly.
• Improve mobility: in scar contracture release, adding pliable tissue can reduce tightness and improve movement (results vary by anatomy and scar biology).
• Rebuild contour: providing soft-tissue thickness where volume is lacking (within the limits of the flap’s thickness).

Typical tools and modalities

• Incisions and surgical dissection to raise the flap while preserving vascularity
• Sutures for inset (securing the flap at the recipient site) and donor-site closure
• Dressings and sometimes drains, depending on surgeon preference and the size of the surgical field
• No implants are inherently required for a supraclavicular flap, although reconstruction may sometimes be combined with other procedures when clinically indicated (varies by case)

supraclavicular flap Procedure overview (How it’s performed)

Exact steps vary by surgeon, defect type, and whether the goal is surface coverage, lining reconstruction, or scar release. A typical workflow is:

1. Consultation
   The clinician reviews the reason for reconstruction (for example, after tumor removal, trauma, or scarring), overall health history, and the goals for function and appearance.

2. Assessment / planning
   Planning includes evaluating the defect size and location, the quality of surrounding tissue, and whether the supraclavicular donor site has appropriate skin and vascular reliability. The flap design is mapped to match the needed shape and reach.

3. Prep / anesthesia
   A supraclavicular flap is performed in an operating-room setting. Anesthesia may be general anesthesia in many cases, though anesthesia choice varies by clinician and case complexity.

4. Procedure (flap elevation and transfer)
   The flap is carefully raised from the supraclavicular region while maintaining blood supply. It is then moved to the recipient site by rotation/advancement or via a tunnel when appropriate. The surgeon positions the flap to cover the defect and aims to achieve a stable, well-vascularized inset.

5. Closure / dressing
   The flap is secured with sutures. The donor site may be closed directly or may require additional techniques if tension is a concern (varies by patient anatomy and flap size). Dressings are applied, and drains may be placed depending on preference and risk of fluid accumulation.

6. Recovery
   Early recovery focuses on monitoring flap viability, wound healing, swelling, and comfort. Follow-up schedules and activity limitations vary by clinician and case.

Types / variations

“supraclavicular flap” is an umbrella term, and clinicians may use different designs depending on the defect and surgical goals. Common variations include:

• Pedicled supraclavicular artery–based flap (often described as an island flap)
  The tissue remains attached to its blood supply and is rotated or advanced into the defect. This is a common concept behind many supraclavicular flap reconstructions.

• Tunneled vs non-tunneled transfer

• Tunneled: the flap passes under a bridge of skin to reach the defect, which can reduce visible incision lines between donor and recipient sites but may increase technical demands.

• Non-tunneled: the flap is rotated directly with an open path, which can simplify positioning but may create additional visible scars.

• De-epithelialized components (selected cases)
  In some reconstructions, portions of the skin surface may be modified so the flap can add bulk or fill space under adjacent tissue (the specifics vary by defect and surgeon).

• Pre-expansion (selected cases)
  Tissue expansion at or near the donor site may be considered in staged reconstruction to increase available skin area. This is case-dependent and not routine for all patients.

• Thickness tailoring
  The surgeon may adjust the thickness of the flap to better match the recipient site’s needs, balancing contour goals with preservation of blood supply (approach varies by clinician).

• Anesthesia choices

• General anesthesia: commonly used for many head and neck reconstructions.
• Sedation with local anesthesia: may be considered for smaller reconstructions in selected settings, depending on patient factors and surgeon preference.

Unlike some reconstructive approaches, supraclavicular flap techniques generally do not involve implants as a defining feature, although reconstruction can be combined with other methods when clinically indicated.

Pros and cons of supraclavicular flap

Pros:

• Uses nearby skin that may provide a reasonable color/texture match for parts of the head and neck (varies by individual)
• Can provide living tissue coverage that is often more durable than a skin graft for certain defects
• Often offers thin, pliable tissue, which can be helpful where bulky reconstruction would be undesirable
• May avoid harvesting tissue from more distant sites (case-dependent)
• Can be adapted in shape and orientation to fit different defect patterns (within anatomical limits)
• May support functional reconstruction in areas where movement and flexibility matter, such as the neck (results vary)

Cons:

• Leaves a donor-site scar above the clavicle/shoulder region, which can be visible depending on clothing and healing
• Flap survival depends on blood supply, and vascular compromise is a recognized risk in flap surgery (risk level varies by case)
• Size and reach are limited; very large or distant defects may require other flap options
• Possible sensation changes (numbness, altered feeling) in donor or recipient areas, which can improve over time or persist
• Potential for contour differences (thickness mismatch, fullness, or indentation) at donor and/or recipient sites
• Recovery may involve activity limitations and follow-up to monitor healing, especially early on

Aftercare & longevity

A supraclavicular flap is intended to provide long-lasting tissue replacement because it transfers living tissue. Longevity, however, is not the same as “no maintenance.” Healing quality and long-term appearance can change with time, scarring, and normal aging.

Aftercare commonly focuses on:

• Wound care and dressing management as directed by the surgical team
• Monitoring for expected post-operative issues such as swelling, bruising, and tightness, especially in the early healing period
• Protecting incisions during the initial healing phase to reduce tension and support scar maturation (specific precautions vary by clinician and case)
• Follow-up visits to assess flap viability, incision healing, and scar development

Factors that can influence durability and appearance over time include:

• Surgical technique and flap design, including how well blood supply is preserved
• Skin quality (elasticity, thickness, tendency toward prominent scarring)
• Defect characteristics, such as whether the area has been previously operated on or irradiated
• Lifestyle factors that affect healing and skin aging, such as sun exposure and smoking (impact varies by individual)
• Weight changes and normal aging, which can alter contour and skin laxity
• Whether additional staged procedures are needed for refinement (for example, debulking, scar revision, or contour adjustments), which varies by clinician and case

Alternatives / comparisons

The “best” reconstruction depends on the defect location, size, tissue requirements (thin vs bulky), and patient-specific factors. Common alternatives include:

• Skin grafting (split-thickness or full-thickness skin grafts)
  Skin grafts can cover superficial defects and may involve shorter operative time, but they require a well-vascularized bed and may contract during healing. They may be less suitable when underlying structures need robust coverage.

• Local flaps (adjacent tissue rearrangement)
  Nearby tissue may be rotated or advanced to close smaller defects with similar skin match. Local flaps can be limited by tissue laxity and may not work for larger losses.

• Regional pedicled flaps (other than supraclavicular flap)
  Options can include flaps from the chest or neck region (for example, larger muscle-based flaps in some settings). These may provide more bulk or reach, but can be thicker and may create different donor-site tradeoffs.

• Free tissue transfer (free flaps)
  Free flaps move tissue from a distant site and reconnect blood vessels using microsurgery. They can reconstruct large or complex defects and offer many tissue-type choices, but typically involve longer operative time, specialized resources, and additional donor-site considerations.

• Tissue expansion and staged reconstruction
  Expanding nearby skin before transfer can improve skin match and surface area in selected cases, but requires multiple stages and time.

• Non-surgical options (limited role)
  Energy-based treatments, topical scar therapies, or injectables may help with scar quality or contour refinement in certain contexts, but they do not replace tissue transfer when there is true tissue loss or exposure requiring durable coverage.

In reconstructive planning, “comparison” is often about selecting the approach that best matches the defect requirements while balancing scar placement, donor-site impact, operative complexity, and expected function.

Common questions (FAQ) of supraclavicular flap

Q: Is a supraclavicular flap cosmetic surgery or reconstructive surgery?
It is primarily a reconstructive technique used to repair tissue loss or damage, especially in head and neck regions. In some situations it may support appearance-related goals (such as improving contour or scar-related tightness), but the underlying purpose is typically reconstruction.

Q: Where is the donor site, and will it be noticeable?
The donor site is usually above the collarbone near the shoulder/neck junction. There will be a scar, and how noticeable it becomes depends on incision placement, healing biology, and scar care practices used by the treating team. Visibility also depends on clothing and individual anatomy.

Q: Does the supraclavicular flap leave a scar at the reconstruction site too?
Yes. Any flap procedure involves incisions at the recipient area to inset and shape the tissue. Scar appearance varies by clinician technique, wound tension, skin type, and how the scar matures over time.

Q: How painful is recovery?
Comfort levels vary widely by individual, the size of the reconstruction, and whether additional procedures are performed at the same time. Many patients report a combination of soreness, tightness, and altered sensation during early healing, which typically evolves over weeks to months. Pain management strategies are individualized by the treating team.

Q: What kind of anesthesia is used?
Many supraclavicular flap reconstructions are done under general anesthesia, particularly for head and neck defects. In selected cases, sedation with local anesthesia may be considered. The choice depends on the complexity of the defect, patient factors, and clinician preference.

Q: How long is the downtime?
Downtime depends on the extent of surgery and whether the reconstruction is combined with other procedures (for example, tumor removal). Early healing often requires follow-up and temporary activity modifications, but the timeline varies by clinician and case. Some patients may need staged revisions later, depending on healing and contour.

Q: How long does a supraclavicular flap last?
Because it transfers living tissue, the reconstruction is generally intended to be durable long term. However, scars, contour, and skin quality can change with aging, weight fluctuation, and sun exposure. Some cases may benefit from secondary refinements, which varies by clinician and case.

Q: What are common risks or complications?
All flap surgeries carry potential risks, which can include wound healing problems, infection, fluid collection, scarring concerns, and partial or complete flap compromise related to blood supply. Numbness or altered sensation can occur at donor or recipient sites. The likelihood of specific complications varies by anatomy, surgical details, and overall health factors.

Q: Can it be used if the area has had radiation therapy?
Radiation can affect tissue quality and healing, so it is an important part of surgical planning. A supraclavicular flap may still be considered in some irradiated-field reconstructions, but suitability depends on local tissue condition and the reconstructive goals. The final decision is individualized.

Q: What determines the cost range?
Costs depend on the complexity of the defect, operative time, facility and anesthesia fees, geographic region, and whether the surgery is medically necessary versus elective. Additional procedures, hospital stay, and follow-up needs can also affect total cost. Exact pricing varies by clinician and case.