Versatility of the Supraclavicular Flap in Head and Neck Reconstruction

F. Martins de Carvalho, MD; Bernardo Correia, MD; Álvaro Silva, MD; Joana Costa, MD

Disclosures

ePlasty. 2020;20(e7) 

In This Article

Abstract and Introduction

Abstract

Objective: Head and neck oncologic resections often leave intricate defects whose reconstruction remains a challenge. The pedicled supraclavicular artery perforator flap is an emerging option, and its applicability in head and neck reconstruction is gaining popularity.

Methods: A retrospective analysis of patients regarding medical history, surgical indication, surgical technique, postoperative complications, and outcomes was carried out on all patients admitted to undergo pedicled supraclavicular artery perforator flap reconstruction within our institution.

Results: Nine pedicled supraclavicular artery perforator flap reconstructions were performed. Surgical indications were 3 pharyngocutaneous fistulas, 2 tracheoesophageal fistulas, 2 cutaneous defects, 1 immediate pharyngoesophageal reconstruction, and 1 cutaneous and intraoral defect. All flaps survived completely. Excluding one patient who required a second flap due to plate reexposure, the remaining functional and esthetic outcomes were good.

Conclusions: The pedicled supraclavicular artery perforator flap is reliable, is quick to harvest, and entails minimal donor site morbidity. Also, it is thin, is pliable, and has a wide arc of rotation, making it extremely versatile. It is an option that should be added to the spectrum of solutions of any head and neck reconstructive surgeon.

Introduction

Head and neck oncologic resections often leave intricate defects whose reconstruction remains a challenge. The complex anatomy, the multiplicity of associated functions, and the desire for an esthetically favorable outcome all contribute to the inherent difficulty of these reconstructions. Advances in microsurgery often lead plastic surgeons to the top of the reconstructive ladder, avoiding morbid regional flaps. However, not all patients are candidates for microsurgery. The pedicled supraclavicular artery perforator (SAP) flap is an emerging option, and its applicability in head and neck reconstruction is gaining popularity.

The first vascular anatomical studies in the supraclavicular region were made by Mathes and Vasconez[1] in the late 1070s who presented the cervicohumeral flap. Further studies were carried out by Lamberty and colleagues,[2,3] who, in 1983, named the supraclavicular artery. However, the applicability of this flap was controversial. Despite its axial pattern, the use of too long flaps led to reports of distal necrosis, reducing its popularity.[4] This period also corresponded to the widespread use of concurrent flaps such as the pectoralis major or the trapezius.[5] Pallua and colleagues[6,7] rediscovered this flap in the 1990s, and the first report regarding its applicability to postburn mentosternal contractures was published in 1997, followed by oncologic head and neck reconstructions.

The purpose of this article is to demonstrate the indications, complications, and outcomes of the SAP flap reconstruction performed within our institution.

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