[Approach to the axillo-subclavian trunk using a sterno-cleido-costal flap]

Difficulty in exposure of the axillary-subclavian arterial trunk has led to the use of a wide approach by means of a lower pedicle flap with section through the middle of the clavicle, a partial upper median sternotomy and an easy to perform section of the first two costal cartilages. Displacement of the flap downwards clearly exposes the origin of and path taken by the subclavian artery, and the axillary artery, allowing temporary proximal and distal hemostasis. Repair of clavicle and sternum by wiring is then a simple and solid procedure. Two cases of subclavian arteriovenous fistula are used to illustrate use of this approach.