Use of Supraclavicular Flap by End to Side Technique in Pharyngeal SCC: A Case Report and Review of Literature

Abstract

Objectives. In recent years, conservation laryngeal surgeries, including partial pharyngectomy, have been introduced as an alternative procedure for selected cases of hypopharyngeal squamous cell carcinoma (HSCC). Reconstruction of these defects presents a considerable challenge for the surgeon after partial pharyngectomy due to its circumferential nature. In this case report, we represent the innovative “End to side” technique to reconstruct hypopharyngeal defect using the rolled supraclavicular flap after laryngeal-preserving partial pharyngectomy. Methods and Results. A 70-year-old female presented with a history of progressive dysphagia and odynophagia. The evaluations revealed a T3N0M0 SCC of pyriform sinus. The mass was successfully resected through partial pharyngectomy, and the hypopharyngeal defect reconstruction was achieved using the rolled supraclavicular flap via the “End to side” technique. The patient was discharged after decannulation on day 10. The 3-week barium swallow was performed with no evidence of anastomotic leakage, and the oral feeding was started after NG tube removal. At week 5, complete movement of the true vocal cord on the one side and good phonation and deglutition was observed. There was no evidence of recurrence after 1 year. Conclusions. Laryngeal-preserving partial pharyngectomy and hypopharyngeal reconstruction with the rolled supraclavicular flap via the “End to side” technique could lead to good oncological and functional outcomes in selected cases of pyriform sinus.

The Supraclavicular Artery Island Flap for Pharynx Reconstruction

“…The type of each study, date of publication, aim, conclusion endpoints and level of evidence were data extracted and presented. Ten full-text articles comprising 92 patients with 93 supraclavicular flaps were included according to the eligibility criteria [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. The procedure is presented in Figure 3 (PRISMA 2020 flow diagram) [ 8 ].…”

“…From the critical appraisal of the ten studies, there were no randomized controlled trials identified. Four studies were conducted in the USA [ 11 , 12 , 13 , 19 ], two in Europe [ 15 , 16 ], one in India [ 17 ], one in Iran [ 20 ] and one in China [ 18 ]. All studies were single-centered [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 21 , 22 ].…”

“…A modification of this technique is the “end-to-side” hypopharyngeal reconstruction for laryngeal-preserving partial pharyngectomy. In this technique, the distal part of the rolled flap, an 8 cm tube, is linked to the proximal part of the cervical esophagus, and the other end of the tubularized flap is attached to the lateral side of the oropharyngeal and postcricoid mucosa, applying the “end-to-side” technique [ 20 ]. On the contrary, the U-shaped supraclavicular pedicle flap for circumferential defects uses the lateral edges of the flap secured to the lateral prevertebral fascia and the distal end of the flap secured to the base of the tongue of the pharynx, giving a final “U” shape [ 16 ].…”

“…In our review, 26 pharyngocutaneous fistulas were reported in 92 patients. More specifically, all the included studies, except for two [ 18 , 20 ], had at least one postoperative pharyngocutaneous fistula. The majority of the patients with fistulas had a history of previous radiation or chemotherapy and radiotherapy combined.…”