Pre-operative imaging of the supraclavicular artery island flap plays a vital role in the flap design

Cervico-acromial flap for large defects in face and neck reconstruction: 34-year experience

BACKGROUND

Extensive cervicofacial defects often lead to functional and aesthetic impairments. The pre-expanded cervico-acromial flap technique is reliable and cost-effective for addressing such defects.

OBJECTIVE

To introduce our 34 years' experience on pre-expanded cervico-acromial flap technique, emphasizing key surgical techniques.

METHOD

The supraclavicular artery and its main branches were evaluated with Doppler ultrasound preoperatively. Pre-expansion was performed in most cases to optimize flap dimensions, with the tissue expander placed at the subfascial level to preserve adequate blood supply. Once fully expanded, the cervico-acromial flap was raised and rotated to cover the cervicofacial defects. The pedicle was divided three weeks postoperatively.

RESULTS

A total of 19 patients (5-57 years) were finally included in this retrospective study. They all accepted the above-mentioned technique by the same senior surgeon from October 1990 to October 2024. The expanded flap sizes ranged from 15 × 7 cm to 35 × 15 cm. The follow-up lasted from 6 months to 9 years. All flaps survived without necrosis or infection. Patients expressed high satisfaction with functional and cosmetic outcomes in both donor and recipient areas.

CONCLUSIONS

The pre-expanded cervico-acromial flap is safe and effective for repairing the extensive cervicofacial defects. Thorough understanding of this flap's blood supply and careful design based on the vascular anatomy help to improve the flap's survival rate.

Supraclavicular Artery Island Flap for Head and Neck Oncologic Reconstruction: 15-year Experience, Past, Present, Future

Head and neck reconstruction poses unique challenges due to the complex structure of the region. Primary goals include soft-tissue coverage, adequate color and texture match, and minimal donor-site morbidity. Local and musculocutaneous regional flaps have largely been replaced with fasciocutaneous free flaps (FFF) over recent years. The supraclavicular artery island flap (SCAIF), a locoregional, fasciocutaneous, axially-based flap, has been shown to produce similar outcomes to FFF. We present our 15-year experience using the SCAIF for head and neck reconstruction, discuss its evolution, and provide case examples for its range of indications.

Methods

Retrospective chart review identified 128 patients who underwent reconstruction of the head and neck with the SCAIF between the years 2006-2021 at Tulane University Medical Center. Patient demographics, lengths of stay, operative times, surgical indications, and complications were recorded.

Results

The cohort mean age was 66.9 years. Mean lengths of stay and follow-up times were 6.9 days and 9.1 months, respectively. The most common indications for SCAIF reconstruction were recurrent radiated neck disease (n=27, 21.1%), pharyngeal wall defects (n=23, 18.0%), and parotidectomy defects (n=21, 16.4%). Overall complication rate was 17.2%. Partial thickness flap loss (5.5%), contained pharyngeal leak (3.2%), and distal tip necrosis (2.4%) were the most common complications. No functional donor site morbidity was encountered.

Conclusions

The SCAIF is a versatile, fasciocutaneous, axially-based flap able to produce similar outcomes to FFF in the reconstruction of the head and neck region while reducing costs, lengths of stay, operative times, and donor site morbidity.