Versatility of Supraclavicular Artery Island Flap in Head and Neck Reconstruction of Vessel-Depleted and Difficult Necks

doi:10.1016/j.joms.2012.07.005

Journal of Oral and Maxillofacial Surgery

Volume 71, Issue 3, March 2013, Pages 622-627

https://doi.org/10.1016/j.joms.2012.07.005 Get rights and content

Purpose

The advent of microvascular free tissue transfer has given reconstructive surgeons a vast repertoire of treatment options for reconstruction of head and neck defects. However, the success of free flaps in head and neck reconstruction depends on the presence and quality of the recipient vessels in the neck for microvascular anastomosis. The supraclavicular artery island flap can be used to reconstruct a variety of head and neck defects, allowing the reconstructive surgeons to circumvent some of the problems inherent in vessel-depleted necks. The present study reports the use of the supraclavicular artery flap (SCAF) in the reconstruction of vessel-depleted neck and in difficult necks.

Materials and Methods

The present study was a retrospective study of patients who had undergone reconstruction with an SCAF and who also had a difficult neck or vessel-depleted neck in the head and neck surgery section from 2011 to 2012. Our inclusion criteria were patients treated at our institution with an SCAF who also had undergone multiple previous neck surgeries or patients with severely restricted donor options for soft tissue reconstruction. We excluded any patient for whom we did not have adequate follow-up or if the flap procedure was not performed by the faculty of the head and neck section.

Results

We identified 8 patients with a total of 9 SCAFs. One patient received bilateral SCAFs. Of the 8 patients, 6 were men and 2 were women. With the exception of 1 patient, all had received previous radiotherapy to the head and neck region. All the patients had undergone multiple surgical procedures. The flap survival was 100%. However, 2 patients had partial loss of the flap, and 2 had partial donor site wound dehiscence. Our overall complication rate was 38%, including dehiscence of the flap and partial loss of the flap.

Conclusions

The SCAF is a sound option for reconstructing defects in the head and neck region in patients with previous radiotherapy and in multiple neck surgeries. The surgeon and patient should be aware of the high incidence of complications associated with this reconstructive option.

Section snippets

Materials and Methods

The present study was an institutional review board-approved retrospective study of patients who had undergone reconstruction with a supraclavicular artery flap (SCAF), who also possessed a difficult neck or a vessel-depleted neck. All the reconstructive surgeries were performed in the head and neck surgery section from 2011 to 2012. Our inclusion criteria were patients treated in our institution with an SCAF who also had undergone multiple previous neck surgeries or patients with severely

Results

A total of 8 patients (6 men and 2 women, age range 34 to 67 years) received SCAFs for reconstruction of various head and neck defects from January 2011 to May 2012. A total of 9 SCAF flaps were used in these 8 patients.

The reasons for the reconstruction included osteoradionecrosis in 5 patients, 1 of whom had simultaneous recurrence of an astrocytoma with osteonecrosis of the temporal bone. Of the remaining 3 patients, 1 presented with a large oropharyngeal fistula after salvage total

Discussion

The past 3 decades have seen remarkable advances in microvascular free tissue transfer with the introduction of numerous soft tissue and bone flaps for head and neck reconstruction. These advances have dramatically improved both form and function in the reconstruction of head and neck defects after cancer extirpation or trauma. With success rates approaching 96% for experienced microvascular surgeons, microvascular free tissue transfer has become the logical reconstructive choice in centers

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Cited by (42)

Supraclavicular artery island flap for reconstruction of hypopharynx and upper esophagus defects: A case report and literature review
2023, Chinese Journal of Plastic and Reconstructive Surgery
We report a case of a 74-year-old female with hypopharyngeal cancer who developed a pharyngoesophageal fistula and neck skin defect after total laryngectomy. To reconstruct the hypopharynx, upper esophagus, and neck skin defect, we used a supraclavicular artery island flap (SCAIF) for one-stage reconstruction. SCAIF offered reliable blood supply, minimal donor site morbidity, and excellent cosmetic outcomes. Although a small portion of the flap developed necrosis, it healed without surgical intervention. We also conducted a literature review of previously published articles on SCAIF for head and neck reconstruction. Our review highlights the advantages and limitations of SCAIF as a promising option for one-stage reconstruction of complex hypopharyngeal and upper esophageal defects with neck skin defects in selected patients. This case report provides valuable insights into the use of SCAIF in complex head and neck reconstructions, which can help improve patient outcomes and quality of life.
Is Supraclavicular Artery Island flap (SAI) a viable alternative to Free Tissue Transfer (FTT) in head and neck reconstruction? A systematic review and meta-analysis.
2023, Journal of Stomatology, Oral and Maxillofacial Surgery
The aim of this study is to compare the outcomes of Supraclavicular Artery Island (SAI) Flap versus Free Tissue Transfer for head and neck reconstruction.
We performed a systematic review of MEDLINE (via PubMed), Scopus and Cochrane Library database according to the PRISMA guidelines. Only comparative studies between the two techniques were included. Random-effects model meta-analyses were performed.
Eight studies, reporting a total of 402 patients and same number of flaps, 165 of which underwent reconstruction using supraclavicular artery island flap and 237 reconstructed with free tissue transfer were identified. No statistically significant differences were observed regarding major complications, total flap necrosis, partial flap necrosis, post operative fistula formation, donor site dehiscence, recipient site dehiscence and total flap area.
Supraclavicular artery island flap and free tissue transfer seem to be comparable when used in head and neck reconstruction.
Head and neck reconstruction: The supraclavicular flap: technical note
2019, Annales de Chirurgie Plastique Esthetique
Citation Excerpt :
SCAIF is also an effective option for tracheostoma reconstruction as proven by Chu et al. series, reporting successful reconstruction of 5 tracheostomas wounds [13]. The SCAIF is technically simple; it is a safe fascio-cutaneous flap that has a low morbidity rate (2–15%) [14–16]. In our series, flap survival was 90%.
Defects reconstruction after oncologic resection is challenging and complex in head and neck tumors. The aim of this retrospective study is to evaluate the use of the supraclavicular artery island flap (SCAIF) in head and neck reconstruction, in particular, when traditional free flaps is not recommended.
We reviewed our two years’ experience of the use of SCAIF on a total of 15 cases. In 10 cases, it was used as an alternative to free flaps after head and neck tumors resection. In 5 cases, SCAIF was used for revision surgery after a free flap failure. The indications for flap use have been defects due to resection of stage II–IV cancer in the head and neck region. The operative site, time, complications and functional outcomes were assessed.
We identified 15 patients with a total of 16 SCAIF. One patient had received bilateral SCAIF. Out of the patients, 10 were men and 5 were women. Head and neck oncologic patients underwent tumor resection followed by immediate reconstruction using SCAIF. Among those 15 patients, 10 received previous radiotherapy in the head and neck region. All the patients had undergone multiple surgical procedures. Mean flap dimensions were 6.0 cm (range, 5–7 cm) wide and 22.0 cm (range, 14–26 cm) long. The proximal part of the flap was de-epithelialized to match the defect, resulting in a mean skin paddle length of 8.0 cm (range, 5–12 cm). After an average follow-up duration of 13 months (range 3–20 months), the flap survival rate was 90%. Two patients had had a partial loss of the flap. All the flaps were harvested in less than one hour. The donor sites were closed primarily and did not require any additional surgery. No donor site wound dehiscence had been reported. No infection or cellulitis were observed. None of the patients reported any functional donor site morbidity.
The supraclavicular flap provides a safe option for head and neck reconstruction of oncologic defects when traditional free flap is not recommended. It is also an excellent alternative to radial forearm free flap (RFFF) in head and neck soft tissue reconstruction, especially in vessel-depleted neck.
La reconstruction des défects après exérèse oncologique des tumeurs des voies aérodigestives supérieures est complexe. Le but de cette étude rétrospective est d’évaluer le lambeau supraclaviculaire et son utilité dans la reconstruction cervicofaciale, en particulier lorsque la reconstruction nécessite des lambeaux libres traditionnels mais qu’elle n’est pas recommandée.
Rétrospectivement, nos deux années d’expérience on été revues dans l’utilisation du lambeau supraclaviculaire. Dans 10 cas, le lambeau a été utilisé en première intention. Dans 5 cas, le lambeau supraclaviculaire a été utilisé comme seconde chirurgie après échec du lambeau libre. Les indications se résumaient à combler les défects après résection de tumeurs cervicofaciales étendues (stade II–IV. Le site, le temps opératoire, les complications et les résultats fonctionnels ont été évalués.
Nous avons identifié 15 patients avec un total de 16 lambeaux. Un patient a bénéficié d’une reconstruction par deux lambeaux. Parmi les patients, 10 étaient des hommes et 5 des femmes. 10/15 des patients ont déjà reçu une radiothérapie préalable. Tous les patients avaient déjà bénéficiés de plusieurs interventions chirurgicales. Les dimensions moyennes des lambeaux étaient de 6,0 cm (extrêmes de 5 à 7 cm) et de 22,0 cm (extrêmes de 14 à 26 cm). La partie proximale du lambeau a été épithélialisée pour correspondre au défect, ce qui donnait une longueur de palette de peau moyenne de 8,0 cm (surface de 5 à 12 cm). Après un suivi moyen de 13 mois (extrêmes: 3 à 20 mois), la viabilité du lambeau était de 90 %. Deux patients ont eu une perte partielle du lambeau. Tous les lambeaux ont été prélevés en moins d’une heure. Les sites donneurs ont été couverts per primam et n’ont pas nécessité de chirurgie complémentaire. Aucune déhiscence du site donneur n’a été rapportée. Aucune infection ou cellulite n’a été observée. Aucun des patients n’a signalé de morbidité fonctionnelle au niveau du site donneur.
Le lambeau supraclaviculaire offre une option sûre pour la reconstruction après exérèse des tumeurs des voies aérodigestives supérieures lorsque les lambeaux libres ne sont pas recommandés, en particulier dans une région cervicale multitraitée et dénuée de structures vasculaires.
The supraclavicular flap
2019, Operative Techniques in Otolaryngology - Head and Neck Surgery
Citation Excerpt :
The flap is a viable alternative to FTT with shorter operative time and comparable complication rate.10,18,19,31 It is reliably used in vessel depleted necks and with prior radiation.32 Its increased use has proven utility in the armamentarium of modern head and neck reconstruction.
In the realm of head and neck reconstruction, many would agree that the pendulum has swung back from free tissue transfer (FTT) to locoregional flaps.¹ The supraclavicular flap has re-emerged in the last several decades as another versatile reconstructive option in the head and neck. The flap is easy to harvest and boasts shorter operative times than FTT.² Several authors have demonstrated that supraclavicular flap is equally as effective as FTT in coverage of a variety of defects with better cost-effectiveness. Technique refinements have improved the rate of flap survival and decreased the complication rate of this procedure with minimal donor site morbidity. The flap does have its restrictions, which include size and reach limitations. This article will give some insight into patient selection, different operative techniques, and postoperative care for this flap.
Supraclavicular flap as a salvage procedure in reconstruction of head and neck complex defects
2019, Journal of Plastic, Reconstructive and Aesthetic Surgery
The supraclavicular island flap (SCIF) is an interesting therapeutic option in head and neck reconstruction. Since popularized by Pallua in the late 90s, several clinical series have been published showing its versatility and usefulness. However, only a few studies have focused on factors associated with complications from SCIF use. In this study, we analyzed the factors contributing to SCIF unreliability. We performed a retrospective review of the data of 87 patients undergoing SCIF reconstruction between 2008 and 2015. No significant differences in mean complication rates were observed when the SCIF was used for primary or salvage reconstruction (28% versus 25%, respectively, p = 0.816) or for cutaneous or intraoral reconstruction (27% versus 28%, respectively, p = 0.932). Flap folding, preoperative radiotherapy, and microsurgery were associated with significantly increased complication rates (p = 0.002, p = 0.043, and p = 0.001, respectively), whereas smoking (p = 0.431) had no impact with regard to this. In conclusion, the SCIF is a versatile flap and an important therapeutic tool for use in salvage surgeries, particularly in those performed in patients with poor clinical conditions and limited flap options.
Soft Tissue Reconstruction for Head and Neck Ablative Defects
2019, Oral and Maxillofacial Surgery Clinics of North America
Citation Excerpt :
An acquired or inherited hypercoagulable disorder is an absolute contraindication to performing microvascular free tissue transfer.8 Radiation treatment has important implications on the choice of flap, as both recipient and donor site can be affected by radiation.9–11 A history of head and neck radiation would limit local flap selection because of a lack of local vascularized tissue availability and may introduce challenges in free tissue transfer (FTT) in a vessel-depleted neck.

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Surgical oncology and reconstructionVersatility of Supraclavicular Artery Island Flap in Head and Neck Reconstruction of Vessel-Depleted and Difficult Necks

Purpose

Materials and Methods

Results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

Br J Plast Surg

Br J Plast Surg

Br J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

Br J Plast Surg

Microvascular surgery in the previously operated and irradiated neck

Microsurgery

Case of deformity from Burns relieved by operation

Am J Med Sci

Vascular anatomy of the supraclavicular area revisited: Feasibility of the free supraclavicular perforator flap

Plast Reconstr Surg

Three- and four-dimensional computed tomographic angiography studies of the supraclavicular artery island flap

Plast Reconstr Surg

The multilobed propeller flap method

Plast Reconstr Surg

Surgical oncology and reconstruction
Versatility of Supraclavicular Artery Island Flap in Head and Neck Reconstruction of Vessel-Depleted and Difficult Necks