Anatomic Insights into the Vascularized Supraclavicular Lymph Node Flap and A Novel Design for Enhanced Lymphedema Surgery

Vascularized lymph node transfer (VLNT) has emerged as a promising surgical treatment for lymphedema, offering the potential to restore lymphatic flow in affected regions. The supraclavicular lymph node flap, in particular, has gained favor due to its abundance of lymph nodes, concealed donor-site scar, and low risk of secondary lymphedema. However, the precise anatomical distribution of lymph nodes and vascular supply within this region remains poorly understood, leading to inconsistencies in flap design and potential complications during harvesting. This study aimed to provide a detailed anatomical analysis of the supraclavicular lymph node flap, focusing on lymph node distribution, vascular characteristics, and a novel flap design to optimize surgical outcomes. Thirty-one supraclavicular lymph node flaps were dissected from 16 soft cadavers. The transverse cervical artery, which primarily originated from the thyrocervical trunk (83%), had a mean diameter of 2.2 ± 0.4 mm, while the transverse cervical vein averaged 3.5 ± 0.7 mm in diameter. One supraclavicular lymph node flap contains an average of 4.2 ± 0.8 nodes. The highest concentration of lymph node (89.7%) is located at second quarter from the medial (sternal) end of the clavicle (zone 2, see text). Based on these findings, we propose a new flap design that focuses on Zone 2, utilizing the posterior border of the sternocleidomastoid muscle as the anterior boundary and the omohyoid muscle as the superior limit. This design minimizes flap size while ensuring adequate lymph node inclusion, reducing the risk of donor-site morbidity and improving surgical precision. Our results demonstrate that the supraclavicular lymph node flap is anatomically suitable for lymph node transfer, with a high concentration of lymph nodes in Zone 2. The proposed flap design offers a practical guide for surgeons, enhancing the efficacy of VLNT procedures and potentially improving outcomes for patients with lymphedema. Preoperative marking of Zone 2 is recommended to maximize lymph node inclusion and optimize surgical success.