Supraclavicular artery island flap (SCAIF): a rising opportunity for head and neck reconstruction

Abstract

Over the last 20 years, free flaps have represented the gold standard for moderate to large head and neck reconstruction. However, regional flaps continue to evolve and still play an important role in a reconstructive surgeon's armamentarium, especially for the more delicate patients who would certainly benefit from simpler surgical procedures. The supraclavicular artery island flap (SCAIF) is a pedicled flap that has recently gained great popularity for reconstruction of most head and neck sites, because of its unusual versatility and wide arc of rotation. SCAIF is a fasciocutaneous flap that is very reliable and both easy and quick to harvest. It is pedicled on the supraclavicular artery, which is a branch of the transverse cervical artery. Between October 2012 and July 2015, at Ospedale San Raffaele (Milan, Italy) and Policlinico San Matteo (Pavia, Italy), we used the SCAIF procedure on 14 patients with cervical and facial skin, oral cavity, oropharyngeal, and hypopharyngeal defects after oncologic surgery or as revision surgery after free-flap failure. The presence of the supraclavicular artery was demonstrated preoperatively by computed tomography angiography. Harvesting time never exceeded 50 min. Functional outcomes were excellent, and the donor site was always closed. We reported only one case of tip desquamation, which was treated conservatively, and two cases of partial flap necrosis, which required revision surgery. In our opinion, SCAIF should be considered to be a valid alternative to free-flap reconstruction, especially for facial and cervical skin, floor-of-mouth, and hypopharyngeal defects; oropharyngeal defects may be harder to reconstruct.

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

“…It is easy to harvest and in terms of economic aspects a very cost-effective solution. 7 , 23 , 30 , 48 Currently, the working horse for reconstructive surgery in HNSCC is still the RFFF. 1 When reconstruction with a free flap is not possible due to comorbidity reasons, pedicled flaps such as the PMF are commonly used in current practice.…”

“…All flap procedures were performed with the standard technique as described by several authors. 7 , 8 , 30 , 48 Before the dissection, the length of the flap needs to be assessed and the anatomical landmarks (clavicle bone, sternocleidomastoideus muscle and trapezoid muscle) identified. As mentioned above, defects up to 7 cm width can be closed primarily.…”

Modalities and State of Art in Oral Cancer Reconstruction

“…In cases of N2 neck with huge or fixed metastatic nodes that impacts the possibility of preserve the submandibular pedicle, a supraclavicular pediculate flap can be harvested specially to reconstruct tongue with a composite cheek defect [22]. This flap previously described, is also recommended in cases when a free flap cannot be performed due to any specific contraindication such as inexperience or lack of a reconstructive team in microvascular surgery or if the patient is in a poor physical condition and a shortened procedure is mandatory [23].…”

Supraclavicular flap practice patterns and outcomes: A survey of 221 AHNS surgeons

“…Single‐institution studies have described reconstruction of oral (i.e., tongue, lip, buccal, palatal, mandibular), facial (i.e., nasal, periorbital, orbital, auriculotemporal), laryngeal, pharyngeal, esophageal, tracheal, posterolateral skull base, neck, and chest wall defects using the SCF . Various authors champion differences in preoperative Doppler use, harvest location, pedicle skeletonization, and suitable defect sites for reconstruction . These SCF practice patterns have yet to be characterized.…”

“…[4][5][6][7] Various authors champion differences in preoperative Doppler use, harvest location, pedicle skeletonization, and suitable defect sites for reconstruction. 3,4,[8][9][10][11][12] These SCF practice patterns have yet to be characterized. Furthermore, SCF outcomes have varied substantially by study.…”