Supraclavicular flap as a salvage procedure in reconstruction of head and neck complex defects

Alves, Helio; Faria, José Carlos Marques de; Santos, Rafael Varella dos; Cernea, Cláudio Roberto; Busnardo, Fábio de Freitas; Gemperli, Rolf

doi:10.1016/j.bjps.2018.12.050

Cited by 11 publications

(8 citation statements)

References 26 publications

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“…2,10,12,13 In addition, postoperative complications can require a second and even more challenging surgery. 14,15 Head and neck reconstructive surgery with a free vascularised tissue flap has a major aesthetic, functional, and social impact because it can result in dysfunction, malformation, and morbidity. 2,10,14 Partial mandibulectomy can lead to muscular detachment and sensory and motor denervation.…”

Section: Introductionmentioning

confidence: 99%

The impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap: a systematic review and meta-analysis

Garip¹,

Dessel

Grosjean

et al. 2021

British Journal of Oral and Maxillofacial Surgery

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Reconstructive surgery with a free vascularised tissue flap is indicated in large defects in the head and neck region, which arise mostly because of head and neck cancer. Tobacco smoking is a major risk factor for head and neck cancer, and many patients undergoing reconstructive surgery in the head and neck have a history of smoking. The objective of this meta-analysis was to determine the impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap. A systematic review was undertaken for articles reporting and comparing the incidence of overall surgical complications after reconstructive surgery with a free vascularised tissue flap between smokers and nonsmokers. Relevant articles were searched using PubMed, Cochrane, and Embase databases, and screened for eligibility according to the PRISMA guidelines. The risk of bias analysis was conducted using the Newcastle-Ottawa quality assessment scale. A meta-analysis was performed to quantitatively compare the incidence rate of overall surgical complications, flap failure, surgical site infection, fistula, and haematoma between smokers and nonsmokers using OpenMetaAnalyst (open source) software. Only qualitative analysis was performed for wound dehiscence, bleeding, nerve injury, and impaired wound healing. Forty-six articles were screened for eligibility; 30 full texts were reviewed, and 19 studies were included in the quantitative meta-analysis. From the 19 studies, 18 were retrospective and 1 was a prospective study. In total, 2155 smokers and 3124 nonsmokers were included in the meta-analysis. Smoking was associated with a significantly increased risk of 19.12% for haematoma (95% Confidence Interval (CI): 4.75-33.49; p < 0.01), and of 4.57% for overall surgical complications (95% CI: 1.97-7.15; p < 0.01). No significant difference in risk was found for flap failure (95% CI: −4.33-9.90; p = 0.44), surgical site infection (95% CI: −0.88-2.60; p = 0.33) and fistula formation (95% CI: −3.81-3.71; p = 0.98) between smokers and nonsmokers. Only for flap failure was a significant heterogeneity found (I 2 = 63.02%; p = 0.03). Smoking tobacco was significantly associated with an increased risk of overall surgical complications and haematoma, but did not seem to affect other postoperative complications. Encouraging smoking cessation in patients who need reconstructive head and neck surgery remains important, but delaying surgery to create a non-smoking interval is not needed to prevent the investigated complications. More high-quality retrospective or prospective studies with a standardised protocol are needed to allow for definitive conclusions.

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Section: Introductionmentioning

confidence: 99%

The impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap: a systematic review and meta-analysis

Garip¹,

Dessel

Grosjean

et al. 2021

British Journal of Oral and Maxillofacial Surgery

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“…One concern is that the SCF may be used in patients with multiple comorbidities who are most likely to encounter complications, producing an inflated complication rate which is more reflective of patient selection than the flap itself 14 . Furthermore, several SCF studies saw both recipient and donor site complications cluster in the same patients, often those considered the most ill or with the most comorbidities 13,15 . It would be important for future evaluations to separate out such patient-/comorbidity-related complications from those of the SCF itself.…”

Section: Discussionmentioning

confidence: 99%

“…14 Furthermore, several SCF studies saw both recipient and donor site complications cluster in the same patients, often those considered the most ill or with the most comorbidities. 13,15 It would be important for future evaluations to separate out such patient-/comorbidity-related complications from those of the SCF itself.…”

Section: Discussionmentioning

confidence: 99%

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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“…The trapezius muscle flap is not considered mainly for oral cavity reconstruction because of its high complication rate (up to 57%) and bulkiness [29] . Although the PMMCF is anexcellent option in salvage procedures, its volume and donor site appearance impose limits, particularly in women (breast distortion), who have a functional deficit due to muscle loss [25,30] .…”

Section: Discussionmentioning

confidence: 99%

“…These results matched with ours although it does not reach statistical significance. In addition, the salvage group had a considerably higher rate of wound dehiscence than the original surgery group (13.0% and 3.6%, respectively) [29,35] . We recommend routine use suction drains one for neck and one for shoulder.…”

Section: Discussionmentioning

confidence: 99%

Donor Site Morbidity of Supraclavicular Artery Island Flap: Egyptian Oncology Center Experience

ZAID¹,

AHMED²,

AWNY

2022

The Medical Journal of Cairo University

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Background: The supraclavicular artery island flap (SCAIF) has been used successfully for head and neck reconstructive purpose especially in oral tumor ablative surgery, providing acceptable outcomes. Aim of Study:To assess morbidity of shoulder after harvesting of SCAIF applied for reconstruction of oral defects after cancer surgery.Patients and Methods: Prospective analytical descriptive case series study including 33 patients with tumors involving oral mucosa diagnosed and managed by wider local excision of tumor, neck dissection (ND) and immediate reconstruction of the resultant defects with pedicled SCAIF. The follow-up was at least 6 months after surgery. Donor site postoperative complications and late morbidity were assessed.Results: Our study included 33 patients (17 males and 16 females); their mean age was 54.3. Postoperative donor site complications occurred in six patients (18.2%); three major complications managed surgically and three minor complications managed conservatively. Our results of donor site complication can be classified according to Clavien-Dindo system as two for grade II; three for grade IIIa, and one for grade IIIb. Late morbidity included Referred sensation and shoulder pain which occurred in 21.2% and 15.2%. Arm movement was nearly normal in most of cases (93.9%), it was affected in only 2 cases only.Conclusions: SCAIF is a safe technically simple thin pliable fascio cutaneous regional flap. It should be considered as a reliable option for reconstruction of oral defect after cancer surgery. Donor site complications after SCAIF harvesting are minimal with little insignificant effect on arm movement and shoulder function.

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Supraclavicular flap as a salvage procedure in reconstruction of head and neck complex defects

Cited by 11 publications

References 26 publications

The impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap: a systematic review and meta-analysis

The impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap: a systematic review and meta-analysis

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

Donor Site Morbidity of Supraclavicular Artery Island Flap: Egyptian Oncology Center Experience

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