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

Abstract

Objectives To describe American Head and Neck Society (AHNS) surgeon supraclavicular flap (SCF) practice patterns and to identify variables associated with SCF complications. Methods The design is a cross‐sectional study. An online survey was distributed to 782 AHNS surgeons between November 11, 2016, and December 31, 2016. The primary outcome was frequency of SCF complications. Independent variables included demographics, training, practice patterns, and SCF techniques. Results Adequate survey responses were obtained from 221 AHNS surgeons. Among these, 54.3% (n = 120) performed supraclavicular flaps (SCFs). Most surgeons used the SCF for cutaneous (n = 85; 78.7%) or parotid–temporal bone (n = 59; 54.6%) defects. Nearly one‐third (n = 31; 29.8%) of surgeons experienced more than a “few” SCF complications. Surgeons experienced fewer pectoralis major flap (P < 0.001) and radial forearm free flap (P < 0.001) complications compared to SCF complications. Univariate analysis demonstrated no association between surgeons with “few” SCF complications and Doppler use in SCF design (P = 0.90), harvest location (P = 0.51), and pedicle skeletonization (P = 0.25). Multivariable logistic regression revealed that surgeons performing more than 30 SCFs compared to less than or equal to 30 SCFs had a greater odds of having “few” SCF complications (odds ratio 7.1, 95% confidence interval [1.1–43.9], P = 0.04). Conclusion A majority of surgeons performing SCFs use the flap to reconstruct cutaneous and parotid–temporal bone defects. The significance of relatively higher SCF complications compared to other routine flaps should be explored further. Surgeon experience with the SCF appears to be significantly associated with SCF success, whereas training characteristics, practice patterns, and technical variations may not be associated with SCF outcomes. Level of Evidence NA Laryngoscope, 129:2012–2019, 2019

Applications of intraoperative angiography in head and neck reconstruction

“…Cervicofacial flaps and SCAIF have a 9% 17 and 18% 18 risk of partial necrosis respectively. A recent survey capturing 221 head and neck surgeons revealed that the rate of complications with SCAIF was 29.8% 19 . In our series when using SCAIF we experienced only one distal tip necrosis (16,6%), and no complications were reported when using cervicofacial flaps.…”

Malnutrition evaluation in head and neck cancer patients: Practice patterns among otolaryngologists and radiation oncologists

“…Prior survey studies assessing practice patterns regarding malnutrition screening demonstrate response rates ranging from 5.7% 19 to 72%, 16 with recent AHNS surveys reporting response rates of 28%. 22,23 To a certain extent, the low response rate may be explained by fatigue bias, which can occur when surveys are lengthy and/or the participant loses interest toward the end of the survey. 24 This can result in the participant skipping questions or marking responses in a random fashion.…”

Advances in oral tongue reconstruction: a reconstructive paradigm and review of functional outcomes

“…The authors identified higher rates of partial flap necrosis, flap dehiscence, fistula, and donor site dehiscence in comparison to non-SCF flap alternatives in mucosal sites [12 ▪ ]. A cross sectional survey of American Head and Neck Society surgeons revealed limited use of SCF with only 31% of surgeons utilizing the flap for oral cavity reconstructions [13]. This reconstruction may have limited value in oral tongue reconstruction.…”