Supraclavicular Flap Research Articles

Evaluation of Pre-expanded Supraclavicular Flap in Reconstruction of Moderate to Severe Post Burn Contracted Neck and Lower Face

Evaluation of Pre-expanded Supraclavicular Flap in Reconstruction of Moderate to Severe Post Burn Contracted Neck and Lower Face

Local Flap Reconstructions in Oral Cavity Defects: An Insight from 104 Cases.

Resection of oral cavity carcinoma often leads to complex defects causing functional and aesthetic morbidity. Providing optimum reconstruction with free flaps becomes challenging in a high-volume center setting with constrained resources. Hence, understanding the local flap technique for reconstructing oral cancer defects is prudent. This study is a retrospective analysis of prospectively operated cases of oral cavity resections which were subsequently reconstructed using local flaps from 2019 to 2022. Patients who underwent reconstruction with either melolabial flap, islanded facial artery myomucosal (FAMM) flap, submental flap, supraclavicular artery island flap, infrahyoid flap, or platysma myocutaneous flap (PMF) were included in this analysis. Eligible patients were followed up to evaluate functional outcomes like oral feeding and to analyze the Performance Status Scale for Head and Neck Cancer. The study included 104 patients. The tongue was the most common subsite, resulting in most hemiglossectomy defects, which were reconstructed using the melolabial flap procedure. Buccal mucosa defects in our series were reconstructed using the supraclavicular flap, whereas the submental flap procedure was the choice for lower lip-commissure defects. Complications such as partial and total flap loss, deep neck infection, and donor site complications like infection and gaping, oral cutaneous fistula, parotid fistula, and seroma were analyzed; the supraclavicular flap presented with a majority of complications. Local flaps are an alternative to free flap reconstruction in select cases with optimum functional outcomes and minimal donor site morbidity. This article comprehensively reviews the surgical steps for various local flap procedures in oral cancer defects.

Safe and reliable use of supraclavicular flaps for head and neck reconstruction.

The supraclavicular flap is a regional flap in the supraclavicular area nourished by the transverse cervical or supraclavicular arteries. This flap gained popularity in the 2000s as it requires less surgical time than free flap reconstruction and has minimal donor-site morbidity. However, a high rate of postoperative complications has been reported. Moreover, there is ongoing debate regarding the indications and limitations of this flap. In this study, we confined the flap design to the supraclavicular fossa, considering flap vascularity and in an effort to minimize donor site morbidity. Between 2014 and 2023, we performed supraclavicular flap reconstruction in 3 cases of cervical skin defects and 1 case of a pharyngeal mucosal defect. The average defect and flap sizes were 7×3.9cm and 11.5×4.4cm, respectively. The lower border of the flap remained above the clavicle, and the lateral border did not exceed the acromioclavicular joint. When the flaps were transferred using the transposition method, the angle of transposition was limited to <90 degrees. When the VY advancement or turnover method was selected, we paid attention to the tension-free flap inset. We successfully reconstructed the defects without flap-related complications, and donor site scars were inconspicuous in all patients. In conclusion, we believe that confining the flap design to the supraclavicular fossa, limiting the indications of this flap to the reconstruction of medium-sized defects, and using tension-free flap insets are important for the successful application of this flap.

AB198. SOH24AB_226. Supraclavicular flap in the reconstruction of oncologic defects in the head and neck

AB198. SOH24AB_226. Supraclavicular flap in the reconstruction of oncologic defects in the head and neck

Reconstruction of Maxillofacial Cancer Defects by Supraclavicular Flaps

Reconstruction of Maxillofacial Cancer Defects by Supraclavicular Flaps

Application of supraclavicular island flap in oral and maxillofacial reconstruction.

(a) Evaluate the reliability of the supraclavicular flap in cervico-orofacial region; (b) investigate the role of computed tomography angiography (CTA) in predicting the post-operative viability of the flap; (c) assess the speech, feeding, and esthetics after reconstruction using this flap. Eleven patients included in this study underwent either conventional or delayed harvesting of the supraclavicular flap (SCF). All the patients had diagnostic computed tomography angiography (CTA) of the supraclavicular flap before the surgery. The mean harvesting time of the flap was 45.45 ± 4.16min. The average length of the flap was 22.64 ± 1.12cm, whereas the mean width of the flap was 6.14 ± 1.14cm. The flap survived in 9 patients, while two patients had complete flap loss. After the surgery, three patients complained of speech difficulties. Two patients had swallowing problems. After the surgery, three patients complained of speech difficulties. Two patients had swallowing problems. Only two patients complained of weakness in the donor site. None of the patients reported that the weakness or pain at the donor site affected their daily activities or quality of life. The pedicled SCF represents a safe and feasible option that can be used to reconstruct a wide array of maxillofacial oncologic defects. However, a study with a larger sample size is recommended to achieve more reliable clinical results for the modified delayed technique modification in terms of their effect on the survival of the supraclavicular flap.

Repaired four cases of hypopharyngeal combined neck skin defects using a folded supraclavicular flap

Objective:To evaluate the outcomes following the use of folded supraclavicular flap repaired hypopharyngeal combined neck skin defects. Methods:Folded supraclavicular flap were designed to repaired four cases of hypopharyngeal combined neck skin defects patients. Evaluate their repair effect （3 men,1 woman; mean age:66 years）. Hypopharyngeal fistula from 3.2 cm×1.8 cm to 4.5 cm×3.8 cm,skin defects in the neck from 3.8 cm×2.2 cm to 5.1 cm×4.5 cm. The folded supraclavicular flap from 8 cm×5 cm to 13 cm×9 cm. Results:All flaps survived, head and neck appearance was satisfactory, and no patient experienced a major complication. All patients resumed an oral diet function. No fistula recurrence or stricture developed after 6-19 months of follow-up. Conclusion:The folded supraclavicular flap is a safe and effective flap Repaired for hypopharyngeal combined neck skin defects.

Submental island flap versus supraclavicular island flap in oral tongue cancer reconstruction: Perioperative and functional outcomes

BackgroundThe primary treatment for oral tongue cancer in both early and advanced stages involves surgical resection, which often affects tongue function. When microvascular free flaps are unsuitable for tongue reconstruction following cancer ablation, locoregional pedicled flaps become viable alternatives, for example, submental and supraclavicular island flaps. This study compares perioperative and functional outcomes between submental and supraclavicular flaps in tongue cancer reconstruction. MethodsThis retrospective cohort study analyzed the outcomes of 46 patients who underwent tongue resection and reconstruction with a submental or supraclavicular island flap between January 2015 and December 2022. We evaluated patient demographics, flap outcomes, postoperative complications, and speech and swallowing outcomes. ResultsThe study included 24 submental and 22 supraclavicular island flap reconstructions. While demographic data were similar between the two groups, the submental island flap group had significantly shorter operative times than the supraclavicular group (291 and 347 min, respectively, p = 0.018), reduced hospital stays (14.8 and 18.6 days, respectively, p = 0.016), fewer major recipient site complications necessitating interventions under general anesthesia (1 and 6 patients, respectively, p = 0.043), and less recipient wound dehiscence (1 and 8 patients, respectively, p = 0.009). Speech and swallowing outcomes were comparable in the two groups. ConclusionThe submental island flap appears to be a more favorable option for tongue reconstruction than the supraclavicular island flap, offering advantages in operative time, length of hospital stays, and lower rates of major complications and wound dehiscence.

The Role of Supraclavicular Flap in Reconstruction Following Resection in Buccal Mucosa Carcinoma.

Buccal mucosa is one of the common subsite for oral carcinoma. Following excision of the buccal mucosa tumor mass various pedicled and free flaps have been used to reconstruct the oral cavity defect. In this age of free flaps various locoregional pedicled flaps have been underrated and overlooked and supraclavicular flap is one of them. This flap meets the functional and cosmetic acceptance of the buccal mucosa defect reconstruction with minimal morbidity to the donor site. This paper presents author's experience of using supraclavicular flap in 10 patients of carcinoma buccal mucosa. In all cases surgical defect was completely covered by the flap, there was no necrosis of the flap. Functional and cosmetic outcome was acceptable in all the patients without compromising oncological clearance.

The Versatility of the Supraclavicular Flap for Head and Neck Reconstruction

Study Design Descriptive study of 17 patients with primary or secondary reconstruction using a supraclavicular flap. Objective Describe the different options for primary and secondary reconstruction using the supraclavicular flap, as well as the complications that may arise. Methods The present study analyzed the outcomes of 17 patients who underwent reconstruction using the supraclavicular artery island flap at the Maxillofacial Department of Hospital Universitario Virgen de las Nieves (Granada, Spain) from November 2017 to June 2023. Results The SCAIF served as the primary reconstructive option in 9 cases, covering skin defects in the parotid region (4 patients), cervical area (1 patient), partial tongue defects (3 patients), and cheek defects (1 patient). Additionally, the flap was used as a secondary reconstructive option in 8 patients affected by osteoradionecrosis (ORN) with bone and plate exposure. Complications included a single case of shoulder joint septic arthritis and 3 patients who experienced cervical fistula and neck infection. Conclusions The supraclavicular flap represents a highly effective option for oncological reconstruction within the head and neck region. This flap is particularly useful in patients with significant clinical concerns and contraindications, both local and systemic, for microsurgical free flap procedures due to its reliability, versatility, and safety.

Clinical Analysis of Supraclavicular Flaps for the Repair of the Pharyngeal Fistula.

Objectives: We explored the value of supraclavicular flaps in repairing pharyngeal fistula. Methods: Patients treated with supraclavicular flaps were included. Data on preoperative radiotherapy, surgical modality, flap size, postoperative healing, and other clinical outcomes were collected. Techniques, indications, and postoperative complications after repairing with supraclavicular flaps were described. A total of 16 male patients aged 58 to 79 years were involved, including 10 cases of postoperative pharyngeal fistula after hypopharyngeal cancer, 5 cases of postoperative pharyngeal fistula after laryngeal cancer, and 1 case of postoperative pharyngeal fistula after laryngeal and esophageal cancer. In 12 patients, the pharyngeal fistula was repaired by double island folding of the supraclavicular flap; in the remaining 4 patients, the pharyngeal fistula was repaired by the supraclavicular flaps combined with the pectoralis major flaps. The supraclavicular flap was 6 to 8 cm in width and 6 to 15 cm in length. Results: One patient developed partial necrosis at the distal end of the flap, which was successfully treated with debridement and dressing. The flaps grew well in the remaining 15 patients. Among them, a patient with a postoperative pharyngeal fistula after hypopharyngeal carcinoma was implanted with radioactive particles for tumor recurrence at the esophageal entrance, and died in the 11th month after surgery. Conclusions: The supraclavicular flap can achieve excellent results in the repair of pharyngeal fistula.

Latissimus Dorsi and DIEP Flaps for Pharyngeal Reconstruction: A Novel Indication.

Complex pharyngeal defects after tumor resection remain a challenging dilemma for reconstructive plastic surgeons. They often benefit from pedicled or free flaps reconstruction to maintain continuity of the aerodigestive tract and protect the great vessels. While pedicle pectoralis major myocutaneous flaps or supraclavicular flaps have been described, microvascular free flaps have largely replaced the use of pedicle flaps. We describe our experience with subtotal and total pharyngeal reconstruction utilizing tubed DIEP (n = 2) and latissimus dorsi free flaps (n = 2). All four patients were smokers and received prior radiation. All patients were able to resume a regular diet and did not suffer any recipient or donor site complications. There were no fistula or total flap losses. In our experience, DIEP and latissimus dorsi free flaps can serve as a valid alternative to radial forearm, jejunal and anterolateral thigh flaps for pharyngeal reconstruction.

Experience of using a supraclavicular flap in reconstruction of oral cavity defects

Introduction. In case of cancer of the oral mucosa at the first stage, the standard treatment approach is radical surgical intervention, with the formation of extensive defects leading to aesthetic and functional disorders. Taking into account the characteristics of defects, choosing a flap is a difficult task. Currently, there is a wide selection of regional and microvascular free flaps. However, not all flaps meet the requirements. The supraclavicular fasciocutaneous flap, being a regional flap, has a number of advantages: easy to harvest, reliable due to the constancy of the vascular pedicle, primary closure of the donor site, scarcity of hair, the possibility of closing various defects of the oral cavity. Aim. To evaluate the possibility of using a supraclavicular flap in patients with oral cancer to restore the defects after surgical treatment.Materials and methods. The study included 10 patients with malignant tumors of the oral cavity who underwent surgical intervention with defect replacement using supraclavicular flap at the N. N. Blokhin National Medical Research Center of Oncology between February of 2015 and May of 2021. In 4 cases, buccal mucosa was affected; in 3 cases, the retromolar area; in 1 case, oral floor mucosa; in 1 case, mandibular alveolar ridge; in 1 case, mobile tongue. Flap sizes were 5–10 × 5–8 cm. Three (3) patients had history of radiotherapy, and 1 of them had a radical dose.Results. In 4 patients without previous radiotherapy, partial flap necrosis was observed. In 1 patient, sutural diastasis in the oral cavity after partial flap necrosis was diagnosed. There were no cases of total flap necrosis and fistula formation. Suture dehiscence in the donor bed was observed in 1 patient only.Conclusion. Use of supraclavicular flap is an option for oral cavity defect replacement after surgical intervention in patients with malignant tumors of the oral cavity producing satisfactory esthetic and functional results. The advantages of this flap are simple flap dissection, reliability of vascular pedicle, flexibility, possibility of replacing large defects, scant hair coverage.

Twelve Years of Establishing the Strategies for Tongue Reconstruction.

Reconstruction after resection of malignant tongue tumors remains one of the most difficult problems in head and neck oncology. Recent trends in tongue reconstruction have focused on optimizing speech and swallowing functions and maximizing quality of life. In the recent literature, several reconstructive strategies including regional flaps and free flaps have been described. A case series of 328 patients underwent oral tongue reconstruction between March 2011 and March 2022. Functional evaluation was performed in all patients 3 months after reconstruction (where the patients required no adjuvant radiotherapy) or after radiotherapy. Total flap necrosis was seen in 5 patients with free flap reconstruction (2 radial forearm flaps, 1 lateral arm flap, and 2 anterolateral thigh flaps), 5 patients with infrahyoid myocutaneous flap, and 1 patient reconstructed with a supraclavicular flap. Our success rate is 96.6%; partial flap necrosis was observed in 11 patients with infrahyoid myocutaneous flap and 2 patients with a supraclavicular flap. Most patients with subtotal glossectomy or smaller defects (type II-IVA defects) could communicate on the phone and had the near-normal capacity for an oral diet. The remaining patients (type IVB-V defects) had significantly lower speech scores. The majority of patients could eat liquid and semiliquid foods. Tongue cancer surgery and subsequent reconstruction posed exciting challenges for the surgeon to optimize tongue function and quality of life for patients. Attention to the principles of tongue reconstruction and choosing appropriate flap for each defect achieve better functional results.

Supraclavicular Artery Island Flap in Head-and-neck Reconstruction: Our Experience

Background: Reconstruction of head-and-neck cancer defects is a challenging task, keeping in mind the complexity of the defects. Locoregional pedicle flap reconstruction is not an inferior option. The supraclavicular flap gained popularity in 1997 to reconstruct mentosternal contractures in postburn patients. This is a perforator-based pedicled, axial, and fasciocutaneous flap based on the supraclavicular artery. This study aims to examine a series of cases with pedicled supraclavicular flap reconstruction in head-and-neck cancers. Methods: This study is a retrospective review of patient data from our institution from 2018 to 2020. A total of seven patients were included who underwent surgical resection for various head-and-neck cancers. Surgical defects were reconstructed with a supraclavicular islanded fasciocutaneous flap. Results: All patients underwent wide excision of the tumor following oncological principles, and four out of seven patients received postoperative adjuvant radiotherapy. Two patients with parotid tumors underwent facial skin excision along with total parotidectomy. Both cases were recurrent. One patient had partial necrosis of the distal part of the flap. Two patients required split-thickness skin graft for the closure of the donor site. Conclusion: Supraclavicular artery island flap (SCAIF) is one of the good reconstructive options for midline neck defects, simple oral cavity defects, and cheek skin defects. It is an excellent alternative to free tissue transfer with limited donor-site morbidity. Careful selection of patients is key to successful reconstruction using a SCAIF in the head-and-neck region.

Supraclavicular flap for head and neck oncological reconstruction: A series of 62 cases

Supraclavicular flap for head and neck oncological reconstruction: A series of 62 cases

Regional pedicled flap salvage options for large head and neck defects: The old, the new, and the forgotten.

The objective of this article is to review options for regional pedicled reconstruction for large head and neck defects in a salvage setting. Relevant regional pedicled flaps were identified and reviewed. Expert opinion and supporting literature were used to summarize and describe the available options. Specific regional pedicled flap options are presented including the pectoralis major flap, deltopectoral flap, supraclavicular flap, submental flap, latissimus flap, and trapezius flap. Regional pedicled flaps are useful options in a salvage setting even for large defects and should be in the armamentarium of any reconstructive head and neck surgeon. Each flap option carries specific characteristics and considerations.

610. NOVEL HYBRID TECHNIQUES FOR DELAYED RECONSTRUCTION OF THE CERVICAL PART OF A LEFT COLON INTERPOSITION: A CASE REPORT

Abstract Conduit necrosis following colon interposition for esophageal replacement is a devastating complication with a high morbidity and mortality rates. Survivors often face a challenging journey of complex reconstructive procedures. A multi-disciplinary approach is paramount to tailor the management according to the patient's anatomy, nutritional and psychological status, conduit alternatives and routes. This case report provides a series of novel reconstructive techniques, each of which could be helpful for esophageal surgeons facing such difficult situation. A 36 years old female, with a history of corrosive ingestion at the age of 5 years, who was subjected to series of regular dilatation since then, presented with a tight stricture not passing a wire. She underwent a subcutaneous isoperistaltic left colon interposition. The postoperative course was complicated with necrosis of the cervical part of the graft with infection of the subcutaneous tunnel. Resection was done with esophagostomy and colostomy in the neck. The patient survived the acute stage, feeding was established through the colostomy opening in the neck. Delayed reconstruction was planned 6 months later. The skin between the two openings in the neck was considered posterior wall of the conduit, and transaxillary pedicled thoracodorsal artery perforator flap (TDAP) was used to reconstruct the anterior wall (1,2). Partial flap loss occurred (3). Debridment and gastrostomy were done. The result was two gaps on both ends of the flap (3). The food regurgitated upwards from the gastrostomy. An antireflux stent was placed inside the flap to bridge the defects and allow oral intake (4). The TDAP-colon side was closed using a local flap from TDAP and skin graft (5,6). The esophageal side was closed primary and covered by a supraclavicular flap (7-12). Management of graft failure should focus on controlling sepsis and nutrition. Attempts should be made to preserve any surviving part of the conduit as long as it doesn’t add to sepsis. A combination of Myocutaneous flaps could be used to replace the cervical part of the conduit as TDAP and supraclavicular flaps. Stent could be used successfully to bridge a failure in a skin flap. Finally, a dedicated team is paramount for a successful outcome.

Oncological safety of harvesting local flaps from the neck in clinically node positive patients with oral squamous cell carcinoma.

e18065 Background: Reconstruction of complex orofacial defects following tumour resection has always posed as a challenge for clinicians for providing functional and morphological outcomes. Though microvascular free flaps revolutionized reconstruction, local flaps provide a viable alternative in resource constraint settings. Oncological safety of harvesting local flaps has always been a matter of debate in oral squamous cell carcinoma due to proximity of nodal stations. Available literature on oncological safety is limited to clinically node negative patients. The purpose of this study was to evaluate the oncologic safety of local flaps in clinically node positive patients. Methods: Retrospective analysis of data available of all patients diagnosed with clinically node positive oral squamous cell carcinoma who underwent modified radical neck dissection at Malabar Cancer Centre during the period January 2012 to December 2017 was done. Demographic profile, tumour characteristics and pathological outcomes were compiled. The factors included were pathological tumour, nodal stage, levels of nodes involved, extranodal extension, choice of flap and site of recurrence. Fisher's exact test was used to compare recurrence patterns between local and regional flaps. Results: A total of 309 clinically node positive patients were analyzed with a median follow up of 4 years. Overall incidence of pathologically proven nodal metastases to ipsilateral levels Ia Ib, II, III, IV and V were 8.1%, 35.3%, 39.5%,15.5%, 2.9% and 1.3% respectively. Level Ia was most commonly involved in buccal mucosa and tongue cancers. Levels Ib, II, III were most commonly involved in tongue and buccal mucosa cancers. Level IV was commonly involved in tongue cancers while level V in cancer of retromolar trigone. Local flaps analyzed were submental flap (2.6%), supraclavicular flap (2.6%), infrahyoid flap (2.6%), sternocleidomastoid muscle flap (4.5%), nasolabial flap (1.3%), facial artery myomucosal flap (1.6%). Pathological nodal positivity was 60% and 52% in local and regional flaps respectively. Amongst the patients who had reconstruction with submental flap there were no nodal recurrences at level Ia, only 1 patient had recurrence at flap site. Amongst the patients who had reconstruction with supraclavicular flap there was 1 patient with pathological involvement of level V as per histopathological report but no nodal recurrences at level V. There was no difference in pattern of nodal recurrence between local and regional flaps (p = 0.436). Conclusions: This retrospective analysis is the first of its kind analysing the oncological safety of harvesting local flaps in clinically node positive oral squamous cell carcinoma. Thus, with appropriate management of the levels Ia and V nodal compartment, oncologic outcomes are not compromised, thereby making it oncologically sound to harvest local flaps in N+ neck.

The role of the supraclavicular flap in salvage laryngectomy

The role of the supraclavicular flap in salvage laryngectomy