The clavipectoral osteomyocutaneous free flap

Area of Science:

• Plastic Surgery
• Anatomy
• Head and Neck Surgery

Background:

• Microvascular free tissue transfer is the gold standard for oromandibular reconstruction.
• Assessing the feasibility of clavicular free vascularized transfer is crucial for expanding reconstructive options.

Observation:

• Forty pectoral region dissections on 26 cadavers detailed thoracoacromial vascular anatomy.
• The clavicle receives primary supply from the clavicular artery, with a minor contribution from the deltoid artery.
• Soft tissues include pectoralis major muscle and overlying skin, supplied by pectoral, deltoid, and clavicular arteries.

Findings:

• Total clavicular harvest yielded an average of 16.1 cm of bone suitable for dental implants.
• The clavipectoral donor site provides vascularized, thin, pliable, hairless soft tissue.
• The thoracoacromial system offers a free flap with osseous and soft tissue components for oromandibular reconstruction.

Implications:

• This technique offers a familiar, efficient, two-team approach with minimal donor site morbidity for head and neck surgeons.
• The clavicular free flap is well-suited for oromandibular reconstruction, despite a relatively short pedicle.
• This study presents the first case of full-thickness free clavicular transfer for mandibular reconstruction in the English literature.