Supraclavicular flap reconstruction following total laryngectomy

Report on the successful use of the supraclavicular flap for reconstruction following total laryngectomy and highlight the utility and versatility of the supraclavicular flap for reconstruction after total laryngectomy.

Retrospective review of a single institution experience.

A single institution database was reviewed to identify patients undergoing total laryngectomy and supraclavicular flap reconstruction. The following data were collected: indication for reconstruction, flap viability, flap size, reconstruction site complication, and donor site complication.

Forty-six supraclavicular flaps were identified in the database from July 2011 to September 2013. Fifteen of these were used following total laryngectomy. Ten flaps were used for patch graft pharyngeal reconstruction, three flaps for cutaneous defects related to previous tracheotomy, one flap for cutaneous and tracheal reconstruction following resection of a recurrence in the stoma, and one flap as a pharyngeal interposition graft. Twelve of these cases were performed in the salvage setting after previous radiation. Three cases had significant oropharyngeal resection that required reconstruction. There was one near complete flap loss. Three patients developed pharyngocutaneous fistula. One patient required an additional surgical procedure to address a complication. Three patients had minor incisional dehiscence. All minor complications resolved with basic wound care. No significant donor site morbidity was identified.

The supraclavicular flap can be successfully used for multiple purposes following total laryngectomy. This has been successfully used for reconstruction of limited pharyngeal defects, extensive pharyngeal resection, and skin reconstruction following previous tracheotomy. This flap can be successfully used following previous radiation and with limited morbidity.