A clinical experience of the supraclavicular flap used to reconstruct head and neck defects in late-stage cancer patients.
The supraclavicular island flap has been widely used in head and neck reconstruction, providing an alternative to the traditional techniques like regional or free flaps, mainly because of its thin skin island tissue and reliable vascularity. Head and neck patients who require large reconstructions usually present poor clinical and healing conditions. An early experience using this flap for late-stage head and neck tumour treatment is reported. Forty-seven supraclavicular artery flaps were used to treat head and neck oncologic defects after cutaneous, intraoral and pharyngeal tumour resections. Dissection time, complications, donor and reconstructed area outcomes were assessed. The mean time for harvesting the flaps was 50 min by the senior author. All donor sites were closed primarily. Three cases of laryngopharyngectomy reconstruction developed a small controlled (salivary) leak that was resolved with conservative measures. Small or no strictures were detected on radiologic swallowing examinations and all patients regained normal swallowing function. Five patients developed donor site dehiscence. These wounds were treated with regular dressing until healing was complete. There were four distal flap necroses in this series. These necroses were debrided and closed primarily. The supraclavicular flap is pliable for head and neck oncologic reconstruction in late-stage patients. High-risk patients and modified radical neck dissection are not contraindications for its use. The absence of the need to isolate the pedicle offers quick and reliable harvesting. The arc of rotation on the base of the neck provides adequate length for pharyngeal, oral lining and to reconstruct the middle and superior third of the face.
Division of Plastic Surgery of Sao Paulo University Medical School, Av Dr Eneas de Carvalho Aguiar, 255 8 Andar, São Paulo, 05403-900, Brazil. heliomed85@yahoo.com
Helio R N
HR
Alves
Luis C
LC
Ishida
Luis H
LH
Ishida
Julio M
JM
Besteiro
Rolf
R
Gemperli
Jose C M
JC
Faria
Marcus C
MC
Ferreira
D000368:Aged; D000369:Aged, 80 and over; D002968:Clavicle; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D009334:Neck Muscles / Q000601:surgery* / Q000637:transplantation; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D056888:Patient Positioning; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology