Supraclavicular Flap Reconstruction of Cutaneous Defects Has Lower Complication Rate than Mucosal Defects

Abstract

Background The objective of this study was to determine whether there was a difference in complication rate between cutaneous and mucosal defects reconstructed with the supraclavicular artery flap.

Methods Retrospective review of postoperative complications in 63 patients from 2008 to 2015 with cutaneous and mucosal head and neck defects following oncologic ablation reconstructed with the supraclavicular flap, with a minimum follow-up duration of 6 months. Of the 63 patients, 38 patients had cutaneous defects, whereas 25 had mucosal defects. Patients were followed up postoperatively to determine the presence of wound infection, partial flap necrosis, complete flap necrosis, and fistula formation. Complications in both defect groups as well as a statistical comparison of total complications were analyzed.

Results Patients with cutaneous defects reconstructed with the supraclavicular flap had significantly lower postoperative complications than those with mucosal defects (p = 0.002). Flap necrosis, both partial and complete, was also lower in this same group (p = 0.0052).

Conclusion The supraclavicular artery flap may be a more suitable option for patients with cutaneous defects, given the reliability and lower propensity for postoperative complications

Level of Evidence The level of evidence is 4.

Keywords

supraclavicular - complications - island flap

• References

• 1 Pallua N, Machens HG, Rennekampff O, Becker M, Berger A. The fasciocutaneous supraclavicular artery island flap for releasing postburn mentosternal contractures. Plast Reconstr Surg 1997; 99 (7) 1878-1884 , discussion 1885–1886
• 2 Pallua N, Magnus Noah E. The tunneled supraclavicular island flap: an optimized technique for head and neck reconstruction. Plast Reconstr Surg 2000; 105 (3) 842-851 , discussion 852–854
• 3 Chiu ES, Liu PH, Friedlander PL. Supraclavicular artery island flap for head and neck oncologic reconstruction: indications, complications, and outcomes. Plast Reconstr Surg 2009; 124 (1) 115-123
• 4 Giordano L, Bondi S, Toma S, Biafora M. Versatility of the supraclavicular pedicle flap in head and neck reconstruction. Acta Otorhinolaryngol Ital 2014; 34 (6) 394-398
• 5 Hanasono MM, Matros E, Disa JJ. Important aspects of head and neck reconstruction. Plast Reconstr Surg 2014; 134 (6) 968e-980e
• 6 Rigby MH, Hayden RE. Regional flaps: a move to simpler reconstructive options in the head and neck. Curr Opin Otolaryngol Head Neck Surg 2014; 22 (5) 401-406
• 7 Emerick KS, Herr MW, Lin DT, Santos F, Deschler DG. Supraclavicular artery island flap for reconstruction of complex parotidectomy, lateral skull base, and total auriculectomy defects. JAMA Otolaryngol Head Neck Surg 2014; 140 (9) 861-866
• 8 Su T, Pirgousis P, Fernandes R. Versatility of supraclavicular artery island flap in head and neck reconstruction of vessel-depleted and difficult necks. J Oral Maxillofac Surg 2013; 71 (3) 622-627
• 9 Kokot N, Mazhar K, Reder LS, Peng GL, Sinha UK. The supraclavicular artery island flap in head and neck reconstruction: applications and limitations. JAMA Otolaryngol Head Neck Surg 2013; 139 (11) 1247-1255
• 10 Yang Y, Ren J, Pang X, Bai Y, Yuan W, Xu W. [Reconstruction of facial and cervical scar with the expanded supraclavicular island flaps]. Zhonghua Zheng Xing Wai Ke Za Zhi 2015; 31 (1) 11-13
• 11 Shenoy A, Patil VS, Prithvi BS, Chavan P, Halkud R. Supraclavicular artery flap for head and neck oncologic reconstruction: an emerging alternative. Int J Surg Oncol 2013; 2013: 658989
• 12 Goyal N, Emerick KS, Deschler DG , et al. Risk factors for surgical site infection after supraclavicular flap reconstruction in patients undergoing major head and neck surgery. Head Neck 2016; 38 (11) 1615-1620
• 13 Nthumba PM. The supraclavicular artery flap: a versatile flap for neck and orofacial reconstruction. J Oral Maxillofac Surg 2012; 70 (8) 1997-2004
• 14 Giordano L, Di Santo D, Occhini A , et al. Supraclavicular artery island flap (SCAIF): a rising opportunity for head and neck reconstruction. Eur Arch Otorhinolaryngol 2016; 273 (12) 4403-4412
• 15 Pabiszczak M, Banaszewski J, Pastusiak T, Szyfter W. Supraclavicular artery pedicled flap in reconstruction of pharyngocutaneous fitulas after total laryngectomy. Otolaryngol Pol 2015; 69 (2) 9-13
• 16 Anand AG, Tran EJ, Hasney CP, Friedlander PL, Chiu ES. Oropharyngeal reconstruction using the supraclavicular artery island flap: a new flap alternative. Plast Reconstr Surg 2012; 129 (2) 438-441
• 17 Teymoortash A, Mandapathil M, Hoch S. Indications for reconstruction of mucosal defects in oropharyngeal cancer using a supraclavicular island flap. Int J Oral Maxillofac Surg 2014; 43 (9) 1054-1058
• 18 Chu MW, Levy JM, Friedlander PL, Chiu ES. Tracheostoma reconstruction with the supraclavicular artery island flap. Ann Plast Surg 2015; 74 (6) 677-679
• 19 Razdan SN, Albornoz CR, Ro T , et al. Safety of the supraclavicular artery island flap in the setting of neck dissection and radiation therapy. J Reconstr Microsurg 2015; 31 (5) 378-383
• 20 Busche MN, Pallua N. Evolution in flap design: from the supraclavicular artery island flap to the anterior supraclavicular artery perforator flap. J Reconstr Microsurg 2016; 32 (3) 242-244