Shoulder Morbidity in Patients after Head and Neck Reconstruction with the Pedicled Supraclavicular Island Flap

Spiegel, Jennifer L.; Pilavakis, Yiannis; Canis, Martin; Welz, Christian

doi:10.1097/gox.0000000000001711

Cited by 10 publications

(29 citation statements)

References 47 publications

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“…After assessment for distal viability, the flap must then be adapted to the defect. In the case of defects within the oral cavity, oropharynx, or hypopharynx, the proximal portion of the flap is de-epithelialized and can be tunneled through the neck or mediastinum to the desired area 5,6,11 . The flap may be inset in a corkscrew fashion to achieve greater diameter in pharyngeal reconstruction.…”

Section: Resultsmentioning

confidence: 99%

“…The success rate of SCF reconstructions, as reported in the literature, is approximately 96% (complete flap failure 3.4%), with reports of minor complications at 24.6%. 11 Selection of the proper reconstructive technique can prove difficult, and ultimately an individually tailored approach should be taken, which accounts for patient sex, defect size, desired flap thickness, prior radiation, comorbidities, ability to endure longer general anesthesia, donor site morbidity, vessel availability and quality, skin color, and more. Particularly in female patients, the SCF allows reconstruction of the head and neck without disruption of breast appearance.…”

Section: Flap Characteristicsmentioning

confidence: 99%

“…5,6 As it is outside of this triangle, the spinal accessory nerve should be preserved during neck dissection. 11,52 Dissection can be done without muscle paralytic administration to aid in nerves identification. 38 The skin paddle itself has parallel longitudinal borders at the edge of the trapezius posteriorly and the deltoid anteriorly.…”

Section: Preoperative Evaluationmentioning

confidence: 99%

“…These are not advocated by all groups when good hemostasis and tight closure are achieved. 11,22,39 The donor site is closed primarily with wide undermining but may require a skin graft if a skin paddle is taken. 9 Estimates for donor site defect widths requiring split thickness skin graft (STSG) vary, ranging from 5 to 10 cm in different reported series.…”

Section: Preoperative Evaluationmentioning

confidence: 99%

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A Comprehensive Review on the Supraclavicular Flap for Head and Neck Reconstruction

et al. 2022

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The supraclavicular artery flap (SCF) is a highly vascularized fasciocutaneous flap overlying the shoulder. The flap was first described in 1979 by Lamberty but did not gain popularity until much later due to lack of a reliable technique. The main advantages of using the SCF include avoiding microsurgical techniques, requiring only a single-stage operation, shorter operative time compared with alternative options, and a wider patient population including those with comorbidities who may be excluded from more extensive operations including free flaps surgeries. The SCF has been successfully performed on individuals with advanced age, poor nutrition, cachexia, obesity, diabetes, tobacco use, severe chronic obstructive pulmonary disease, hypertension, coronary artery disease, peripheral vascular disease, supraventricular tachycardia, atrial fibrillation, heart failure, asthma, and steroid use. The largest disadvantages of the SCF include the possibility of distal tip necrosis, size limitation without pre-expansion, and a moderately visible donor site scar. The following review and meta-analysis of the SCF details its use historically as both an island and a pedicle flap, and its application in head and neck reconstruction.

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Section: Resultsmentioning

confidence: 99%

Section: Flap Characteristicsmentioning

confidence: 99%

Section: Preoperative Evaluationmentioning

confidence: 99%

Section: Preoperative Evaluationmentioning

confidence: 99%

See 2 more Smart Citations

A Comprehensive Review on the Supraclavicular Flap for Head and Neck Reconstruction

et al. 2022

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“…Some degree of limitation in range of motion in abduction and external rotation was seen in most patients, although strength was preserved. Spiegel et al 43 also used a patient-reported survey and found no differences in pain, range of motion, and extremity strength between the SAI flap side and nonoperated side. Referred sensation to the shoulder, especially in patients with mucosal reconstruction during oral intake, was observed in a number of patients.…”

Section: Complicationsmentioning

confidence: 99%

Supraclavicular Artery Island Flap: Critical Appraisal and Comparison to Alternate Reconstruction

et al. 2020

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Objectives/Hypothesis: The supraclavicular artery island (SAI) flap may be a good option for selected head and neck reconstruction due to its reliability, ease of harvest, and favorable color match. The objective of this study was to examine the rates of complications for the SAI flap in head and neck oncologic reconstruction, with examination of risk factors and comparisons to alternative flaps often considered the gold-standard soft-tissue flaps for head and neck reconstruction: the pectoralis myocutaneous (PMC), radial forearm free flap (RFFF), and anterolateral thigh (ALT) flaps.Study Design: Retrospective cohort study. Methods: Consecutive SAI flaps were compared to PMC, RFFF, and ALT flaps (non-SAI flap group), all performed by the senior author from 2010 to 2018. The non-SAI flaps were included if an SAI flap could have been performed as an alternate flap. The groups were compared based on demographics, flap dimensions, site of reconstruction, operating time, total hospital stay, total hospital costs, and complications.Results: One hundred seven SAI flaps and 194 non-SAI flaps were identified. SAI flaps were used less commonly than non-SAI flaps for mucosal defects (P < .001). The SAI flap dimensions were narrower but longer than non-SAI flaps (P < .001). SAI flaps had higher rates of total complications, partial flap necrosis, flap dehiscence at the recipient site, fistula, donor site dehiscence, and minor complications compared to non-SAI flaps (all P < .05). SAI flaps had higher rates of total complications, recipient site dehiscence, fistula, and minor complications in both the oral cavity and all mucosal sites compared to non-SAI flaps (all P < .05). SAI flaps for mucosal reconstruction were associated with higher rates of total complications (54% vs. 34%, P = .04), flap dehiscence at the recipient site (32% vs. 14%, P = .03), and major complications (21% vs. 5%, P = .02), compared to cutaneous reconstruction. Complications were equivalent between SAI flaps and non-SAI flaps for cutaneous reconstruction (all P > .05). Multivariate analysis showed that SAI flaps were associated with any postoperative complication (odds ratio [OR]:

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Versatility of the supraclavicular artery island flap for head and neck reconstruction

Ru,

Ye,

Chen

et al. 2024

Laryngoscope Investig Oto

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ObjectiveTo present our experience using the supraclavicular artery island flap (SCAIF) for head and neck reconstruction.MethodsWe performed a retrospective chart review to identify patients who underwent head and neck reconstruction with SCAIF at our institution. The following data were collected: age, sex, surgical indications, flap harvest time, flap dimensions, length of hospital stay, complications, and clinical outcomes.ResultsThirty‐three patients underwent SCAIF reconstruction, of whom four underwent pectoralis major myocutaneous flap reconstruction simultaneously. Twenty flaps were used to repair pharyngeal or esophageal defects following resection for tonsillar, hypopharyngeal, laryngeal, and cervical esophageal cancers. Five flaps were used for tracheal reconstruction following resection for tracheal or thyroid gland cancer. Seven flaps were used for reconstruction of cervical skin defects or fistulas related to a previous treatment. One flap for tracheal stenosis following tracheotomy. The mean age of the patients was 60.69 ± 11.47 years. The mean flap harvest time was 32.00 ± 4.44 min. The mean flap size was 10.16 ± 3.91 × 5.78 ± 0.68 cm. The mean length of hospital stay is 24.84 ± 13.78 days. Three patients had partial necrosis of the distal portion of the flap, which resolved with anti‐infection therapy and local wound care. One patient developed a fistula that was resolved with wound care and further surgical intervention. Complete flap loss or major complications were not observed. No donor site complication or compromised shoulder function was observed.ConclusionThe SCAIF can be successfully used to reconstruct head and neck defects with good outcomes and limited morbidity.Level of Evidence4.

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Shoulder Morbidity in Patients after Head and Neck Reconstruction with the Pedicled Supraclavicular Island Flap

Abstract: Supplemental Digital Content is available in the text.

Cited by 10 publications

References 47 publications

A Comprehensive Review on the Supraclavicular Flap for Head and Neck Reconstruction

A Comprehensive Review on the Supraclavicular Flap for Head and Neck Reconstruction

Supraclavicular Artery Island Flap: Critical Appraisal and Comparison to Alternate Reconstruction

Versatility of the supraclavicular artery island flap for head and neck reconstruction

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