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Supraclavicular Flap

Supraclavicular Flap

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Preoperative Considerations

Consent:

  • Limited neck/arm range of motion
  • Esthetic concerns

Anesthesia/Positioning:

  • Supine
  • Shoulder rolll for next extension

Other:

  • Supine

Armamentarium:

  • Doppler with jelly
  • Marking Pen
  • #15/10 blade
  • Monopolar/Bipolar Electrocautery
  • Double Prong Skin Hooks
  • Tenotomy scissor
  • #9 Periosteal elevator
  • 2-0 Vicryl
  • Penrose drain
  • Skin Stapler

Technique

Postoperative Considerations

Immediate:

  • Nutrition consult

Follow Up:

  • Consider physical therapy referral

Operative Note

Surgeon(s): ***

Assistant Surgeon(s):  ***

Preoperative Diagnosis: ***

Postoperative Diagnosis: Same

Procedure(s): ***

Anesthesia: General

Implants: None

Specimen:***

Drains: None

Fluids: See anesthesia record

EBL: Minimal

Complications: None

Counts:  Correct x2

Indications: ​***

Findings: As expected

Procedure in Detail:

The patient was seen in the preoperative holding area with a H&P was updated, consents were verified, surgical site marked, and all questions and concerns related to the proposed procedure were discussed in detail.  The patient was transferred to the operating room by the anesthesia team.  The patient underwent general anesthesia with endotracheal intubation. Tegaderms were placed over the eyes. The patient was prepped and draped in the standard fashion for maxillofacial procedures.  A time-out was performed and the procedure began.

A supraclavicular flap was planned based on the transverse cervical artery. An incision was made along the planned lines, starting from the supraclavicular region, extending towards the deltoid. The flap was elevated in a subfascial plane, preserving the vascular pedicle. Meticulous dissection was carried out to ensure the integrity of the transverse cervical artery and its perforators. Hemostasis was achieved with bipolar cautery. The flap was then transposed to the neck defect without tension. The donor site was closed primarily with minimal tension, and a drain was placed to prevent seroma formation. The flap was inset into the neck defect with interrupted 4-0 absorbable sutures for the deeper layers and 5-0 nylon for the skin. The flap was monitored for adequate perfusion, and there were no signs of venous congestion or arterial insufficiency.

The patient's face was then cleaned and the posterior pharynx was suctioned. An OG tube was used to suction out the contents of the stomach. Tegaderms were removed from the eyes. Dressings were placed. The patient was then transferred back to the care of the anesthesia team for extubation and recovery.

Coding

  • 20969: Reconstruction of the neck with a local tissue flap, which may be more appropriate depending on the specifics of the flap and reconstruction involved.
  • 13131: Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 2.6 cm to 7.5 cm.
  • 13132: Each additional 5 cm or less (List separately in addition to code for primary procedure).
  • 14040: Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; defect 10 sq cm or less.
  • 14301: Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm.

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