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Almutairi N, Alshareef W, Almakoshi L, Zakzouk A, Aljasser A, Alammar A. Comparison Between Flap and Primary Closures of Persistent Tracheocutaneous Fistula: A Scoping Review. EAR, NOSE & THROAT JOURNAL 2023:1455613231179690. [PMID: 37291885 DOI: 10.1177/01455613231179690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Objectives: To compare the susceptibility and complication rates between flap and primary closures for tracheocutaneous fistula (TCF). Methods: We searched 4 online databases (Web of Science, Cochrane Library, PubMed, and Scopus) for relevant articles published from study inception until August 2022. Studies including at least 5 adult or child patients with persistent TCFs who underwent closure surgery via primary or flap repair were included. All included studies reported outcomes of surgical repairs such as successful closure rates and complications. In addition, we performed single-arm meta-analyses for each surgical method using the Open Meta-Analyst software to calculate the pooled event rate with a 95% confidence interval (CI); compared the 2 surgical procedures using the Review Manager software using the risk ratio with 95% CI; and assessed study quality based on the National Heart, Lung, and Blood Institute criteria. Results: Overall, 27 studies with 997 patients were included. No significant difference was observed between the closure success and major complication rates of surgical methods. The primary and flap closures had overall success rates of 0.979 and 0.98, respectively. The overall major complication rates in primary and flap closures were 0.034 and 0.021, respectively; and that of minor were 0.045 and 0.04, respectively. In primary closure, a significant decrease in the success rate with increasing age at the time of decannulation was observed. In addition, the risk of major complications increased with increasing time from decannulation to closure. Conclusions: Both the primary and flap repairs of TCF are effective based on closure success and complication rates; therefore, they are both acceptable therapeutic alternatives, and flap repair can be considered when other techniques have failed. However, further prospective randomized studies comparing these 2 procedures are needed to support our results.
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Affiliation(s)
- Nasser Almutairi
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
- Department of Otolaryngology-Head and Neck Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Waleed Alshareef
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Latifah Almakoshi
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdulmajeed Zakzouk
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdullah Aljasser
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ahmed Alammar
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
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Yosefof E, Tsur N, Boldes T, Najjar E, Mizrachi A, Shpitzer T, Hamzany Y, Bachar G. The Predictors of Persistent Posttracheostomy Tracheocutaneous Fistula and Successful Surgical Closure. Otolaryngol Head Neck Surg 2023. [PMID: 36856603 DOI: 10.1002/ohn.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/16/2022] [Accepted: 11/30/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Persistent tracheocutaneous fistula is a well-described complication of prolonged tracheostomy, with a prevalence of about 70% when decannulation is performed after more than 16 weeks. Predictors of its occurrence and outcome of treatment in adults remain unclear. The aim of the study was to describe our experience with the treatment of persistent posttracheostomy tracheocutaneous fistula in adults and to investigate factors associated with its formation and with the success of surgical closure. STUDY DESIGN Retrospective cohort. SETTING Tertiary medical center. METHODS Patients who underwent open-approach tracheostomy between 2000 and 2020 were identified by database review. Data on background, need for surgical closure, and the surgical outcome was collected from the medical files and analyzed statistically between groups. RESULTS Of 516 patients identified, 127 with sufficient long-term follow-up data were included in the study. Compared to patients whose fistula closed spontaneously (n = 85), patients who required surgical closure (n = 42) had significantly higher rates of smoking, laryngeal or thyroid malignancy, and airway obstruction as the indication for tracheostomy, on both univariate and multivariate analysis. In a comparison of patients with successful (n = 29) or failed (n = 11) surgical closure, factors significantly associated with failure were prior radiotherapy and lower preoperative albumin level, on univariate analysis. CONCLUSION Smoking, thyroid or laryngeal malignancy, and airway obstruction indication are risk factors for persistent posttracheostomy tracheocutaneous fistula. Patients should be closely followed after tracheostomy and referred for surgery if the fistula fails to close. Before surgery, careful evaluation of the patient's nutritional status and consideration of prior radiation treatment is mandatory.
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Affiliation(s)
- Eyal Yosefof
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Tsur
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Boldes
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Esmat Najjar
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Mizrachi
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Thomas Shpitzer
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Hamzany
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gideon Bachar
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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D'Aco LF, Cagnoni L, Murè C, Piazza A, Aresi G, Panciera DT. Surgical Use of Supraclavicular Artery Flap for Head and Neck Cancer Defects Repair: Personal Experience. Int Arch Otorhinolaryngol 2022; 27:e117-e122. [PMID: 36714897 PMCID: PMC9879638 DOI: 10.1055/s-0042-1744169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 01/26/2022] [Indexed: 02/01/2023] Open
Abstract
Introduction For a long time, major surgical defects after oncological surgery have always been challenging cases for surgeons in terms of wound healing and covering technique. Objectives To demonstrate the feasibility of supraclavicular artery flap (SCAF) in the reconstruction of surgical defects in those "fragile" patients undergoing oncological surgery who could not possibly have endured the timeframes involved in using microvascular free flaps. Methods Between January 2018 and January 2019, at the Azienda Socio Sanitaria Territoriale (ASST) Bergamo Est Hospital (Bergamo, Italy), we reported the cases of 11 patients in whom the SCAF was used for surgical reconstruction after oncological surgery in our Otolaryngology Department. The median age of the 11 patients was 68.7 years old. Results The SCAF has proved, in almost all 11 cases in which it was used, to be very reliable and, above all, easy and quick to make in those "fragile" patients without the need for further intervention. There was only one case in which the resection involved the auricle entirely and a small area of perimeatal bone exposure occurred, which, anyway, healed by secondary intention. Conclusion The SCAF is an extremely versatile flap for head and neck surgery to be considered especially for fragile and vulnerable patients who cannot undergo prolonged surgical time. Moreover, this technique has also shown high feasibility in small hospitals where there is not a plastic surgery department and the surgeon may face the difficulty of practicing surgical reconstruction after enlarged resection.
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Affiliation(s)
- Luigi Filippo D'Aco
- Department of Otorhinolaryngology, Azienda Socio Sanitaria Territoriale (ASST) Bergamo Est, Hospital Bolognini, Seriate (BG), Italy,Address for correspondence Laura Cagnoni medical doctor, Azienda Socio Sanitaria Territoriale (ASST) Bergamo est – Hospital “Bolognini,” Department of OtorhinolaryngologyVia Paderno 21, 24068, Seriate (BG)Italy
| | - Laura Cagnoni
- Department of Otorhinolaryngology, Azienda Socio Sanitaria Territoriale (ASST) Bergamo Est, Hospital Bolognini, Seriate (BG), Italy,Address for correspondence Laura Cagnoni medical doctor, Azienda Socio Sanitaria Territoriale (ASST) Bergamo est – Hospital “Bolognini,” Department of OtorhinolaryngologyVia Paderno 21, 24068, Seriate (BG)Italy
| | - Carmelo Murè
- Department of Otorhinolaryngology, Azienda Socio Sanitaria Territoriale (ASST) Bergamo Est, Hospital Bolognini, Seriate (BG), Italy,Address for correspondence Laura Cagnoni medical doctor, Azienda Socio Sanitaria Territoriale (ASST) Bergamo est – Hospital “Bolognini,” Department of OtorhinolaryngologyVia Paderno 21, 24068, Seriate (BG)Italy
| | - Alessandro Piazza
- Department of Otorhinolaryngology, Azienda Socio Sanitaria Territoriale (ASST) Bergamo Est, Hospital Bolognini, Seriate (BG), Italy,Address for correspondence Laura Cagnoni medical doctor, Azienda Socio Sanitaria Territoriale (ASST) Bergamo est – Hospital “Bolognini,” Department of OtorhinolaryngologyVia Paderno 21, 24068, Seriate (BG)Italy
| | - Giuseppe Aresi
- Department of Otorhinolaryngology, Azienda Socio Sanitaria Territoriale (ASST) Bergamo Est, Hospital Bolognini, Seriate (BG), Italy,Address for correspondence Laura Cagnoni medical doctor, Azienda Socio Sanitaria Territoriale (ASST) Bergamo est – Hospital “Bolognini,” Department of OtorhinolaryngologyVia Paderno 21, 24068, Seriate (BG)Italy
| | - Davide Thomas Panciera
- Department of Otorhinolaryngology, Azienda Socio Sanitaria Territoriale (ASST) Bergamo Est, Hospital Bolognini, Seriate (BG), Italy,Address for correspondence Laura Cagnoni medical doctor, Azienda Socio Sanitaria Territoriale (ASST) Bergamo est – Hospital “Bolognini,” Department of OtorhinolaryngologyVia Paderno 21, 24068, Seriate (BG)Italy
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Hamidian Jahromi A, Horen SR, Miller EJ, Konofaos P. A Comprehensive Review on the Supraclavicular Flap for Head and Neck Reconstruction. Ann Plast Surg 2022; 88:e20-e32. [PMID: 35502968 DOI: 10.1097/sap.0000000000003098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT 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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Affiliation(s)
- Alireza Hamidian Jahromi
- From the Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL
| | - Sydney R Horen
- From the Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL
| | - Emily J Miller
- Department of Plastic Surgery, University of Tennessee Health Science Center (UTHSC), Memphis, TN
| | - Petros Konofaos
- Department of Plastic Surgery, University of Tennessee Health Science Center (UTHSC), Memphis, TN
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5
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Muangsiri P, Tanjapatkul R, Sriswadpong P, Jomkoh P, Jirawatnotai S. Indocyanine Green Fluorescence Angiography of the Transverse Cervical Arterial Supply to Clavicle Flaps: An Anatomical Study. Otolaryngol Head Neck Surg 2021; 166:68-73. [PMID: 33784191 DOI: 10.1177/01945998211000432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the anatomy of the transverse cervical artery and to prove its perfusion to the clavicle using indocyanine green fluorescence angiography as an alternative vascularized bone for head and neck reconstruction. STUDY DESIGN Cadaveric dissection. SETTING Anatomy lab. METHODS Twenty-two necks and shoulders from 11 fresh-frozen cadavers were dissected. The transverse cervical artery diameter, length, emerging point, and the length of clavicle segment harvested were described. Photographic and near-infrared video recordings of the bone's medial and longitudinal cut surfaces were taken prior to, during, and after indocyanine green injection. RESULTS The transverse cervical artery originated from the thyrocervical trunk and emerged at the level of the medial one-third of the clavicle in 22 of 22 (100%) specimens. The average length of the pedicle was 3.6 cm (range, 2.2-4.4 cm), and the mean diameter was 2.5 mm (range, 1.8-3.4 mm). The harvested bone had a mean length of 5.1 cm (range, 4.3-5.8 cm). After injecting the indocyanine green, 22 of 22 (100%) specimens showed enhancement in the periosteum, bony cortex, and medulla. CONCLUSION The middle third of the clavicle can be reliably harvested as a vascularized bone with its perfusion solely from the transverse cervical artery pedicle, as shown by the near-infrared fluorescence imaging. The pedicle was sizable and constant in origin.
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Affiliation(s)
- Pichtat Muangsiri
- Department of Plastic and Reconstructive Surgery, Lerdsin Hospital, Bangkok, Thailand
| | - Rungkit Tanjapatkul
- Department of Plastic and Reconstructive Surgery, Lerdsin Hospital, Bangkok, Thailand
| | - Papat Sriswadpong
- Department of Plastic and Reconstructive Surgery, Lerdsin Hospital, Bangkok, Thailand
| | - Pojanan Jomkoh
- Department of Plastic and Reconstructive Surgery, Lerdsin Hospital, Bangkok, Thailand
| | - Supasid Jirawatnotai
- Department of Plastic and Reconstructive Surgery, Lerdsin Hospital, Bangkok, Thailand
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6
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Kao CN, Liu YW, Chang PC, Chou SH, Lee SS, Kuo YR, Huang SH. Decision algorithm and surgical strategies for managing tracheocutaneous fistula. J Thorac Dis 2020; 12:457-465. [PMID: 32274112 PMCID: PMC7138993 DOI: 10.21037/jtd.2020.01.08] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Persistent tracheocutaneous fistula (TCF) is a complication of prolonged use of tracheostomy tube. Although many procedures exist to correct this issue, there is no consensus regarding its optimal management. We constructed a decision algorithm to determine appropriate surgical strategies for TCF repair. Methods Retrospectively reviewing our hospital’s records, we found fourteen consecutive patients who had received surgical repair of tracheocutaneous fistula (primary closure or advanced local flap) between February 2013 and December 2018 and collected data relevant to their cases. Results We identified 11 male and 3 female patients. Duration of tracheostomy dependence was 8.1±4.7 months, and timespan from decannulation to surgical closure 7.4±6.5 months. Seven patients received primary closures, six received hinged turnover flaps, and one received random and perforator flap reconstruction. There was no perioperative mortality or morbidity except for one patient requiring a repeat tracheostomy 11 months after TCF repair due to pneumonia and subsequent respiratory failure. We used our findings and those reported in the literature to construct a modified risk factor scoring system based on patient’s physical status, major comorbidities, perifistular soft tissue condition, and nutritional status and an algorithm for managing TCF based on the patients’ fistula size and modified risk factor scores. Conclusions In conclusion, we were able to review our cases and those of other studies to create a risk scoring system and a decision algorithm that we believe will help optimize patient-directed surgical management of TCF repair.
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Affiliation(s)
- Chieh-Ni Kao
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Yu-Wei Liu
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Po-Chih Chang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.,Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Shah-Hwa Chou
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.,Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Su-Shin Lee
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.,Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung.,Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung
| | - Yur-Ren Kuo
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.,Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung.,Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung
| | - Shu-Hung Huang
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.,Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung.,Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung
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7
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Giordano L, Di Santo D, Bondi S, Marchi F, Occhini A, Bertino G, Grammatica A, Parrinello G, Peretti G, Benazzo M, Nicolai P, Bussi M. The supraclavicular artery island flap (SCAIF) in head and neck reconstruction: an Italian multi-institutional experience. ACTA ACUST UNITED AC 2019; 38:497-503. [PMID: 30623895 PMCID: PMC6325652 DOI: 10.14639/0392-100x-1794] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/22/2017] [Indexed: 11/23/2022]
Abstract
The supraclavicular artery island flap (SCAIF) is a thin and pliable pedicled flap that is easy and quick to harvest. Thanks to its particular features and high reliability, it is best indicated for the elderly or most fragile patients. SCAIF is very versatile, as it can be used for reconstruction of oral cavity, oropharynx, hypopharynx, facial and cervical skin and tracheostomal defects. We began using this flap in four Italian tertiary referral centres, with several indications, both as first treatment and as salvage surgery. The aim of the study was to demonstrate the easy reproducibility of the flap among four different centres. A series of 28 patients underwent head and neck reconstructions with SCAIF with no recorded complications during flap harvesting. After the very first cases, harvesting time was approximately 45 minutes; 24 patients had successful flap integration at the recipient site, while the remaining 4 suffered from partial flap necrosis, two of whom needed revision surgery. Other minor complications were reported at the recipient site, always at the most distal and most delicate portion of the flap. Donor site was always closed primarily, with only three cases of partial suture dehiscence. We only selected the most fragile patients for SCAIF reconstruction, such as the elderly or those with one or more comorbidities; for this reason, we reported some serious systemic complications and one intraoperative death. SCAIF is an easy reproducible flap, with multiple possible indications. Its use as an alternative to free flaps in the head and neck region is nowadays under discussion. Its use should be encouraged among head and neck surgeons thanks to its various advantages.
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Affiliation(s)
- L Giordano
- Otolaryngology Service, Head and Neck Department, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - D Di Santo
- Otolaryngology Service, Head and Neck Department, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - S Bondi
- Otolaryngology Service, Head and Neck Department, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - F Marchi
- Department of Otorhinolaryngology-Head and Neck Surgery, Ospedale Policlinico San Martino, University of Genoa, Italy
| | - A Occhini
- Department of Otorhinolaryngology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy
| | - G Bertino
- Department of Otorhinolaryngology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy
| | - A Grammatica
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy
| | - G Parrinello
- Department of Otorhinolaryngology-Head and Neck Surgery, Ospedale Policlinico San Martino, University of Genoa, Italy
| | - G Peretti
- Department of Otorhinolaryngology-Head and Neck Surgery, Ospedale Policlinico San Martino, University of Genoa, Italy
| | - M Benazzo
- Department of Otorhinolaryngology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy
| | - P Nicolai
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy
| | - M Bussi
- Otolaryngology Service, Head and Neck Department, San Raffaele Hospital, Vita-Salute University, Milan, Italy
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Utility and Versatility of the Supraclavicular Artery Island Flap in Head and Neck Reconstruction. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018. [DOI: 10.1016/j.otoeng.2017.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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9
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Transverse Cervical Artery Perforator Flap: Standardized Surgical Technique and Multiple Reconstructive Opportunity in Head and Neck Surgery. Ann Plast Surg 2017; 79:577-582. [PMID: 28604549 DOI: 10.1097/sap.0000000000001144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The main purpose of head and neck reconstructive surgery is to provide anatomic restoration of the demolited region and to provide preservation and recovery of function. The anatomical investigations conducted over the years has enabled a detailed knowledge of human body vascularization, giving the opportunity to design and harvest more and more versatile and refined flaps, with increasingly satisfactory results. Even if in the last 2 decades free flaps have been considered a reconstructive criterion standard, they still determine a great physical impact for the patient and require a certain surgical experience. In particular, perforator flaps (based on vessels that, emerging from the main deep axis, supply superficial myofascial cutaneous tissues) represent the new reconstructive frontier, of which a wide variety of types has been described. Our purpose is to illustrate the preparation and harvesting of the transverse cervical artery perforator flap and the variety of its utilization in head and neck reconstruction. From February 2005 to May 2015, 41 reconstructions were performed, and not only for oncologic reasons. Thanks to its anatomical features, reduced donor site morbidity and rapid preparation, this flap is a safe and feasible alternative to most famous free and locoregional flaps. Because our outcomes in functional and aesthetic terms were mostly satisfying, we can assert that the transverse cervical artery perforator flap has an important role in an appropriate reconstructive strategy for head, neck, and oropharyngolaryngeal region.
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10
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González-García JA, Chiesa-Estomba CM, Sistiaga JA, Larruscain E, Álvarez L, Altuna X. Utility and versatility of the supraclavicular artery island flap in head and neck reconstruction. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017; 69:8-17. [PMID: 28506450 DOI: 10.1016/j.otorri.2017.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/22/2017] [Accepted: 03/12/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The supraclavicular island flap is a rotational pedicled flap and may have some advantages in head and neck reconstruction compared with free-tissue transfer when this kind of reconstruction is not affordable or recommended. MATERIAL AND METHODS We present our experience during the year 2016 in the application of the supraclavicular island flap in five cases as an alternative to microvascular reconstruction in several defects after resection of head and neck tumours. In two patients, the flap was used to close the surgical pharyngostoma after total laryngectomy with partial pharyngectomy. In one patient, it was used in lateral facial reconstruction after partial resection of the temporal bone. In one case, it was used to close a skin defect after total laryngectomy with prelaryngeal tissue extension. And in the last case to close a neck skin defect after primary closure of a pharyngo-cutaneous fistula. There were no flap complications, and the result was satisfactory in all cases. RESULTS The supraclavicular artery island flap is useful and versatile in head and neck reconstruction. Operating room time in aged patients or those with comorbidities will be reduced compared to free flaps. The surgical technique is relatively easy and can be used for skin and mucosal coverage. CONCLUSION The supraclavicular island flap could be a recommended option in head and neck reconstruction, its use seems to be increasing and provides a safe and time-saving option to free flaps in selected patients.
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Affiliation(s)
- José A González-García
- Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital Universitario Donostia-Donostia Unibersitate Ospitalea, Donostia-San Sebastián, Gipuzkoa, España.
| | - Carlos M Chiesa-Estomba
- Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital Universitario Donostia-Donostia Unibersitate Ospitalea, Donostia-San Sebastián, Gipuzkoa, España
| | - Jon A Sistiaga
- Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital Universitario Donostia-Donostia Unibersitate Ospitalea, Donostia-San Sebastián, Gipuzkoa, España
| | - Ekhiñe Larruscain
- Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital Universitario Donostia-Donostia Unibersitate Ospitalea, Donostia-San Sebastián, Gipuzkoa, España
| | - Leire Álvarez
- Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital Universitario Donostia-Donostia Unibersitate Ospitalea, Donostia-San Sebastián, Gipuzkoa, España
| | - Xabier Altuna
- Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital Universitario Donostia-Donostia Unibersitate Ospitalea, Donostia-San Sebastián, Gipuzkoa, España
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Abstract
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.
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Affiliation(s)
- Norbert Pallua
- Department of Plastic and Reconstructive Surgery, Hand Surgery - Burn Center, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany.
| | - Bong-Sung Kim
- Department of Plastic and Reconstructive Surgery, Hand Surgery - Burn Center, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany
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The Supraclavicular Flap in Head and Neck Reconstruction. CURRENT OTORHINOLARYNGOLOGY REPORTS 2016. [DOI: 10.1007/s40136-016-0126-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Maldonado AA, Chen R, Chang DW. The use of supraclavicular free flap with vascularized lymph node transfer for treatment of lymphedema: A prospective study of 100 consecutive cases. J Surg Oncol 2016; 115:68-71. [PMID: 27449974 DOI: 10.1002/jso.24351] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 06/27/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Vascularized lymph node transfer (VLNT) is gaining popularity for treatment of lymphedema. The purpose of this study was to evaluate the flap and the donor site morbidity of the supraclavicular (SC) VLNT. METHODS A review of a prospective database was performed for patients who had undergone SC VLNT to treat upper or lower extremity lymphedema. Flap and donor site complications were registered for each patient. A detailed technical surgical approach is explained. RESULTS One hundred consecutive patients with lower or upper extremity lymphedema underwent SC VLNT (84% from the right side) with a mean of 11-months follow-up (range 3-19 months). There were no flap loss but three flaps (3%) required re-exploration due to venous congestion of the skin paddle. Two patients had local infection and three patients developed chyle leak (3%) at the donor site but resolved spontaneously. No donor site secondary lymphedema was noted. CONCLUSIONS This is the largest prospective series of SC free flap VLNT for treatment of lymphedema. Low flap and donor site morbidity makes this flap an appealing source of lymph node transfer for lymphedema treatment. J. Surg. Oncol. 2017;115:68-71. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Andres A Maldonado
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Ru Chen
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - David W Chang
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
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Supraclavicular artery island flap (SCAIF): a rising opportunity for head and neck reconstruction. Eur Arch Otorhinolaryngol 2016; 273:4403-4412. [PMID: 27170317 DOI: 10.1007/s00405-016-4092-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
Abstract
Over the last 20 years, free flaps have represented the gold standard for moderate to large head and neck reconstruction. However, regional flaps continue to evolve and still play an important role in a reconstructive surgeon's armamentarium, especially for the more delicate patients who would certainly benefit from simpler surgical procedures. The supraclavicular artery island flap (SCAIF) is a pedicled flap that has recently gained great popularity for reconstruction of most head and neck sites, because of its unusual versatility and wide arc of rotation. SCAIF is a fasciocutaneous flap that is very reliable and both easy and quick to harvest. It is pedicled on the supraclavicular artery, which is a branch of the transverse cervical artery. Between October 2012 and July 2015, at Ospedale San Raffaele (Milan, Italy) and Policlinico San Matteo (Pavia, Italy), we used the SCAIF procedure on 14 patients with cervical and facial skin, oral cavity, oropharyngeal, and hypopharyngeal defects after oncologic surgery or as revision surgery after free-flap failure. The presence of the supraclavicular artery was demonstrated preoperatively by computed tomography angiography. Harvesting time never exceeded 50 min. Functional outcomes were excellent, and the donor site was always closed. We reported only one case of tip desquamation, which was treated conservatively, and two cases of partial flap necrosis, which required revision surgery. In our opinion, SCAIF should be considered to be a valid alternative to free-flap reconstruction, especially for facial and cervical skin, floor-of-mouth, and hypopharyngeal defects; oropharyngeal defects may be harder to reconstruct.
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Kim MS, Lim JH, Jin YJ, Jang JH, Hah JH. Trichloroacetic Acid Chemocauterization: A Simple Method to Close Small Tracheocutaneous Fistula. Ann Otol Rhinol Laryngol 2016; 125:644-7. [PMID: 27067152 DOI: 10.1177/0003489416642788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of chemocauterization using trichloroacetic acid with or without suturing for the small tracheocutaneous fistula closure METHODS The Seoul National University Hospital database was analyzed retrospectively for 55 patients with a small tracheocutaneous fistula measuring less than 5 × 5 mm(2). Of these, 39 patients were treated by chemocauterization only, and 16 patients were treated by chemocauterization with suturing. Demographic, perioperative data, and treatment outcomes were evaluated for all patients. RESULTS The success rate of single trial was 56.4% (31/55), and the final success rate after repeated procedures if indicated was 80.0% (44/55). There were no statistically significant differences in age, sex, cannulation period, fistula size, presence or absence of maturation suture during tracheostomy, number of procedures, and success rates. Interval between decannulation and procedure was significantly different among 2 groups. CONCLUSIONS Trichloroacetic acid chemocauterization could be a simple, noninvasive, and safe method to close small tracheocutaneous fistula.
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Affiliation(s)
- Min-Su Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Gyeonggi-do, Korea
| | - Jae Hyun Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Young Ju Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jeong Hun Jang
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - J Hun Hah
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
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Razdan SN, Albornoz CR, Ro T, Cordeiro PG, Disa JJ, McCarthy CM, Stern CS, Garfein ES, Matros E. Safety of the supraclavicular artery island flap in the setting of neck dissection and radiation therapy. J Reconstr Microsurg 2015; 31:378-83. [PMID: 25769088 DOI: 10.1055/s-0035-1546294] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The supraclavicular artery island flap (SAIF) has recently been repopularized as a versatile and reliable option for reconstruction of oncological head and neck defects. Prior ipsilateral neck dissection or irradiation is considered a relative contraindication to its use. The aim of this study was to describe the safety and utility of the SAIF for head and neck reconstruction in the setting of neck dissection and radiation. METHODS A retrospective chart review was performed of consecutive SAIF reconstructions at two institutions between May 2011 and 2014. In addition to demographic data, comorbidities, indications, surgical characteristics, data about radiation treatment, and neck dissection were specifically recorded. Donor and recipient site complications were noted. Fisher exact test was performed to analyze if neck dissection or radiation were associated with complications. RESULTS A total of 22 patients underwent SAIF reconstruction for an array of head and neck defects. Donor site infection was noted in one patient. Recipient site complications included, wound dehiscence (n = 2), orocutaneous fistula (n = 1), carotid blowout (n = 1), and total flap loss (n = 1). There was no association between prior neck dissection or radiation treatment and flap loss (p = 1.00). CONCLUSION The SAIF is safe for use in patients who have had an ipsilateral neck dissection involving level IV or V lymph nodes and/or radiation treatment to the neck. It can be used alone or in combination with other flaps for closure of a variety of head and neck defects.
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Affiliation(s)
- Shantanu N Razdan
- Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York
| | - Claudia R Albornoz
- Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York
| | - Teresa Ro
- Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York
| | - Peter G Cordeiro
- Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York
| | - Joseph J Disa
- Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York
| | - Colleen M McCarthy
- Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York
| | - Carrie S Stern
- Division of Plastic and Reconstructive Surgery, Montefiore Medical Center, New York
| | - Evan S Garfein
- Division of Plastic and Reconstructive Surgery, Montefiore Medical Center, New York
| | - Evan Matros
- Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York
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Abstract
BACKGROUND Surgical wounds on the central face present reconstructive challenges given the aesthetic prominence of these visually important areas and a general lack of local tissue availability. MATERIALS AND METHODS Illustrative case examples demonstrate the potential clinical utility of nontraditional island flaps that are tunneled or transposed into operative defects. RESULTS Aesthetically successful reconstruction of difficult facial wounds was accomplished with island flaps that used less traditional operative designs. CONCLUSION When designed and executed properly, island flaps offer unrivaled opportunities to reconstruct the face with maximal preservation of central facial symmetry.
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Hunt JP, Buchmann LO. The supraclavicular artery flap for lateral skull and scalp defects: effective and efficient alternative to free tissue transfer. J Neurol Surg Rep 2014; 75:e5-e10. [PMID: 25083389 PMCID: PMC4110155 DOI: 10.1055/s-0033-1358376] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 06/27/2013] [Indexed: 11/15/2022] Open
Abstract
Objectives Describe the use of the supraclavicular artery flap for reconstruction of lateral skull and scalp defects. Discuss advantages and potential limitations of the supraclavicular artery flap. Design Case series. Setting Tertiary care academic medical center. Participants Patients undergoing lateral scalp and skull base resections. Main Outcome Measures Effectiveness in reconstructing lateral skull base defects and complications. Results All three patients reconstructed with the supraclavicular artery flap had excellent reconstructive outcomes. There were no flap losses, either complete or partial. There were no major complications, but one patient had a significant donor site dehiscence requiring local wound care. Referred sensation to the shoulder was alleviated by division of the sensory innervations into the flap. Conclusions The supraclavicular artery flap is an excellent option for lateral skull and scalp defects, and donor site morbidity is limited. It should be considered as an alternative to free tissue transfer.
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Affiliation(s)
- Jason P Hunt
- Division of Otolaryngology, Department of Surgery, University of Utah, Salt Lake City, Utah, United States
| | - Luke O Buchmann
- Division of Otolaryngology, Department of Surgery, University of Utah, Salt Lake City, Utah, United States
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Granzow JW, Suliman A, Roostaeian J, Perry A, Boyd JB. Supraclavicular artery island flap (SCAIF) vs free fasciocutaneous flaps for head and neck reconstruction. Otolaryngol Head Neck Surg 2013; 148:941-8. [PMID: 23554114 DOI: 10.1177/0194599813476670] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE At our institution, the supraclavicular artery island flap (SCAIF) has become a reliable option for fasciocutaneous coverage of complex head and neck (H&N) defects. We directly compare the outcomes of reconstructions performed with SCAIFs and free fasciocutaneous flaps (FFFs), which have not been reported previously. STUDY DESIGN Retrospective chart review. SETTING Tertiary academic medical center. SUBJECTS AND METHODS Retrospective review of consecutive single-surgeon H&N reconstructions using fasciocutaneous flaps over 5 years. Reconstructions were divided into 2 groups: SCAIFs and FFFs. Patient demographics, surgical parameters, and outcomes were compared statistically between groups. RESULTS Thirty-four flaps were used in H&N reconstruction (18 SCAIFs and 16 FFFs). There was no difference in patient demographics, distribution of defects, or follow-up (SCAIF 9.2 vs FFF 15.13 months, P = .65) between the 2 groups. The SCAIFs were larger than the FFFs (164.6 ± 60 vs 111 ± 68 cm(2), P < .05) and had shorter total operative times (588 ± 131 vs 816 ± 149 minutes, P < .05). Intensive care unit (ICU) length of stay was shorter for the SCAIF vs the FFF group (1.8 vs 5.6 days, P < .05). Overall morbidity was not significantly different (SCAIF 39% vs FFF 44%, P = NS). CONCLUSION The SCAIF is a technically simpler and equally reliable sensate fasciocutaneous flap for H&N reconstruction with comparable outcomes, shorter operative time, less ICU stay, and no need for postoperative monitoring when compared with using FFFs. It should be considered a first-choice reconstructive option for complex H&N defects.
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Affiliation(s)
- Jay W Granzow
- Division of Plastic & Reconstructive Surgery, Harbor-UCLA Medical Center, Torrance, California 90509, USA.
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Granzow JW, Suliman A, Roostaeian J, Perry A, Boyd JB. The supraclavicular artery island flap (SCAIF) for head and neck reconstruction: surgical technique and refinements. Otolaryngol Head Neck Surg 2013; 148:933-40. [PMID: 23554115 DOI: 10.1177/0194599813484288] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We have found the supraclavicular artery island flap (SCAIF) to be a reliable, first-line tool for the reconstruction of complex head and neck defects. Here, we review our technique of flap elevation and summarize the current literature citing important contributions in the evolution of this flap. DATA SOURCES Medline literature review of supraclavicular artery island flap or shoulder flap in head and neck reconstruction with particular emphasis on developments within the past 5 years. REVIEW METHODS Literature review of technique, indications, anatomy, modification, and outcomes of the supraclavicular artery island flap. CONCLUSION The supraclavicular artery island flap is an important and reliable option in head and neck reconstruction. We use the flap routinely in our practice as a first-line technique when fasciocutaneous soft-tissue reconstruction is required, and we provide a detailed summary of the flap elevation and inset. IMPLICATIONS FOR PRACTICE The supraclavicular artery island flap is a safe, reliable, technically simple, sensate, thin, pliable fasciocutaneous regional flap option that has low morbidity. It provides sensate, single-stage reconstruction for a variety of head and neck defects and should be considered as a first-line option in head and neck reconstruction.
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Affiliation(s)
- Jay W Granzow
- Division of Plastic & Reconstructive Surgery, Harbor-UCLA Medical Center, Torrance, California 90509, USA.
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Moving forwards: The anterior supraclavicular artery perforator (a-SAP) flap. J Plast Reconstr Aesthet Surg 2013; 66:489-96. [DOI: 10.1016/j.bjps.2012.11.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 10/26/2012] [Accepted: 11/15/2012] [Indexed: 11/17/2022]
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Agócs L, Lévay B, Boér A, Elek J. [Pedicled supraclavicular osteocutan island flap for tracheostoma closure]. Magy Seb 2012; 65:426-429. [PMID: 23229035 DOI: 10.1556/maseb.65.2012.6.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Authors present a case of a 52-year-old female patient, who underwent an emergency tracheostomy due to life threatening dyspnoea caused by an external compression of a large goiter. Total thyreoidectomy needed to be carried out later, too. Since the atypical tracheostomy did not close spontaneously a reconstruction was planned. A part of the anterior wall of the trachea needed to be replaced, which was done by an osteocutaneous flap on raised on the supraclavicular artery. An island on the artery was harvested with a thin bone chip taken from the coracoid process of the clavicle, which was rotated into the defect then. The bone chip was sutured to the trachea wall and the donor site was closed primarily. Having reviewed the literature the authors propose the application of this flap in a wide range of cases. The advantages of this flap are the satisfactory functional and cosmetic results, as well as the fact that the donor site does not need skin grafting.
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Affiliation(s)
- László Agócs
- Országos Onkológiai Intézet, Daganatsebészeti Centrum Mellkassebészeti Osztály 1122 Budapest Ráth György utca 7-9.
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Nthumba PM. The supraclavicular artery flap: a versatile flap for neck and orofacial reconstruction. J Oral Maxillofac Surg 2012; 70:1997-2004. [PMID: 22177819 DOI: 10.1016/j.joms.2011.08.043] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 08/30/2011] [Accepted: 08/31/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE The supraclavicular skin is thin and pliable; it closely resembles that of the neck and facial skin, making it the perfect source of tissue for neck and orofacial reconstructions. The author sought to provide a concise compilation of the use of the supraclavicular artery flap, including surgical landmarks, modifications, uses, common complications, and anomalies, and experience with the use of the flap in a sub-Saharan African country. MATERIALS AND METHODS A literature search was performed on the Internet and PubMed for anatomic and clinical studies/reports in the English language on the supraclavicular artery flap with a minimum of 10 subjects and sufficient data on postoperative complications. RESULTS Five anatomic studies (2 of which included clinical cases) and 12 clinical series qualified for inclusion. These articles included 146 flaps from 73 cadaveric studies and 376 supraclavicular flaps in patients (including a series of 22 flaps by the present author). The supraclavicular artery was present in 99% of anatomic dissections and was a branch of the transverse cervical artery in 91% of anatomic dissections. Safe margins for elevation of the supraclavicular artery flap were delimited anteriorly by the clavicle, posteriorly by the superior border of the trapezius, and distally by the insertion of the deltoid muscle. Common flap complications included tip and partial flap necroses. The flap was used successfully in nononcologic and oncologic reconstructions, even with concurrent neck dissection. CONCLUSIONS The pedicled supraclavicular fasciocutaneous flap is emerging as a versatile reconstructive tool for the neck and orofacial regions. It is an excellent option, especially in resource-poor environments and in patients in whom free flaps may be technically difficult. Anatomic and clinical studies have shown it to be consistently reliable, with excellent color matching for the face and neck regions, and have established reliable surgical landmarks, modifications, uses, common complications, and anomalies.
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Affiliation(s)
- Peter M Nthumba
- Plastic, Reconstructive, and Hand Surgery Unit, AIC Kijabe Hospital, Kijabe, Kenya.
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