Infraclavicular free flap for head and neck reconstruction: Surgical description and early outcomes in 7 consecutive patients

Distally based Chinese forearm flap in preventing impending necrosis from ring entrapment: Surgical case report

INTRODUCTION

Ring entrapment is a medical condition that can lead to severe consequences, including nerve damage, ischemia, and impending necrosis. The condition often necessitates surgical intervention to prevent complications such as amputation.

CASE PRESENTATION

We report a case of a 49-year-old male with impending necrosis of the right little finger due to steel ring entrapment. The patient presented with severe edema, signs of infection, and undetected finger saturation on pulse oximetry.

DISCUSSION

The Distally Based Chinese Forearm Flap (CFA) was used for soft tissue coverage, which has advantages like reliable vascularization and long pedicle rotation. The CFA flap has shown to be effective in restoring perfusion to the distal tissue and facilitating early wound closure.

CONCLUSION

The use of CFA in this case resulted in a viable flap and good finger function, demonstrating its effectiveness in managing impending necrosis due to ring entrapment.

Transverse cervical artery anterior perforator flap for head and neck oncological reconstruction: Preliminary study

BACKGROUND

To describe the indications, technique, and our experience in the application of the transverse cervical artery anterior perforator flap (ap-TCAF) for reconstruction of head and neck oncological defects.

METHODS

From September 2016 to September 2019, 11 patients underwent surgical treatment for head neck squamous cell carcinoma and were subsequently reconstructed with ap-TCAFs. The clinical details were recorded, and the postoperative appearance and function were analyzed.

RESULTS

The ap-TCAF was used to reconstruct intraoral defects in eight patients and to repair an oropharyngeal defect in one patient. In two remaining patients, the ap-TCAF was divided into two to restore defects with both an intraoral and extraoral component. The flap size ranged from 6 × 4 cm to 15 × 9 cm. All flaps healed uneventfully. There was no delayed wound healing or dysfunction at the donor site.

CONCLUSIONS

The ap-TCAF is reliable with characteristics making it useful for head and neck oncological reconstruction, especially in male patients.

Regional Salvage Flap Options in Head and Neck Reconstruction

Microvascular free tissue transfer is the standard in the complex head and neck reconstruction with success rates greater than 95%. Free tissue transfer allows for more versatility in reconstructing complex defects with better tissue match. Failures, however, do occur and subsequent free tissue transfer might not be an option due to either the patients' health or in a vessel depleted neck. In these challenging salvage scenarios, the head and neck reconstructive surgeon must turn to regional flaps for reconstruction. Here, we review multiple regional flap options for salvage head and neck reconstruction.

Subclavicular flap: A valid reconstructive option among anterior chest flaps in oral cancer patients

BACKGROUND

The subclavicular pedicled flap is based on the thoracic branch of the supraclavicular artery, and it represents a versatile reconstructive option for low-middle third face defects. Since its use in head and neck surgical oncology has not been popularized yet, we propose its application for oral cavity reconstruction after cancer resection by showing favorable results.

METHODS

Eighteen subclavicular pedicled flaps were used to treat intraoral defects after oral squamous-cell cancer resection between June 2015 and December 2018. Tumor dissection type, complications, donor and reconstructed area results, and functional and aesthetic outcomes were assessed.

RESULTS

No major complications were observed and all of the flaps survived. Adjuvant therapy was administered without delay when needed, and all of the patients had normal functional outcomes and good aesthetic results.

CONCLUSIONS

The subclavicular flap is an excellent choice for the reconstruction of oral cavity defects. Selection of patients should exclude positive lower-third neck node and include appropriate informed consent for women due to the possibility of deformity of the breast. In our opinion, this flap has the potential for common application given its consistent anatomy and donor site advantages, including long pedicle, high pivot point, and relatively unlimited flap width.

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

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.

The pre-expanded subclavicular island flap: A new tool for facial reconstruction

BACKGROUND

The anterior chest is an excellent donor site for cervicofacial reconstruction. Studies of chest flaps began as early as 1988 at our institution. We identified a new branch of the supraclavicular artery that nourishes the anterior chest, and on the basis of this finding, we created a new flap called the subclavicular flap. Unlike the supraclavicular flap, which is pedicled by the deltoid branch, this flap is primarily pedicled by the thoracic branch, and it shares similar vascular territory with the deltopectoral flap. In China, this flap has been widely used for neck reconstruction since our first publications on it in 1993. However, reports of its application are limited. To popularize the use of this flap, we present our experiences with pre-expanded subclavicular island flaps for the repair of facial scars.

METHODS

Fifteen patients with facial scars underwent reconstruction with these flaps. All flaps underwent pre-expansion before being transferred to the face through a subcutaneous tunnel. The pivot point was in the supraclavicular region and allowed the flap to reach the mid-face without compulsive positioning. Donor sites were closed primarily.

RESULTS

Flaps sizes ranged from 4 cm × 5 cm-10 cm × 17 cm. Fourteen flaps survived completely with satisfactory colour and texture. Total flap loss occurred in one patient, who was then treated by harvesting a skin graft from the dying flap. One patient experienced venous congestion, and the flap was successfully salvaged by pure vein anastomosis.

CONCLUSION

Pre-expanded subclavicular island flaps have similar benefits to supraclavicular and deltopectoral flaps, and they may emerge as one of the best choices for cervicofacial reconstruction globally.

Pre-expanded Supraclavicular Artery Perforator Flap

The supraclavicular artery perforator (SAP) flap is a versatile flap for the reconstruction of head and neck defects. Recently, the authors have modified the SAP flap by using an anterior branch of the transverse cervical artery. The anterior SAP flap allows the harvest of a tissue island in the deltopectoral fossa, which is even thinner, is more pliable, and shows a superior color match to the face and neck compared with the original SAP flap. Pre-expansion increases flap size considerably, enabling the coverage of extended defects without the need of microsurgery.

Pedicled adipofascial infraclavicular flap: Elevation technique and its use for maintaining neck contour and vessel coverage after radical and modified radical neck dissection

BACKGROUND

The pedicled adipofascial infraclavicular flap (ICF) is based on the anterior perforator of the supraclavicular artery and supplies the fasciocutaneous tissue of the upper chest. This flap may be used to address neck contour defects and vessel coverage after radical and modified radical neck dissections (MRNDs).

METHODS

We described the pedicled adipofascial ICF elevation technique and its use immediately after neck dissections in order to maintain soft tissue volume and vessel coverage. A video of the operation is provided.

RESULTS

Our results demonstrated satisfactory neck contours with adequate volume replacement, great vessel coverage, and little donor-site morbidity.

CONCLUSION

The pedicled adipofascial ICF is a technically straightforward operation with broad possible applications in head and neck surgery. It may be useful to provide vascularized soft-tissue coverage and maintain neck contour after neck dissections. © 2016 Wiley Periodicals, Inc. Head Neck 38: First-1582, 2016.