Head and neck reconstruction: The supraclavicular flap: technical note

Defects reconstruction after oncologic resection is challenging and complex in head and neck tumors. The aim of this retrospective study is to evaluate the use of the supraclavicular artery island flap (SCAIF) in head and neck reconstruction, in particular, when traditional free flaps is not recommended.

We reviewed our two years' experience of the use of SCAIF on a total of 15 cases. In 10 cases, it was used as an alternative to free flaps after head and neck tumors resection. In 5 cases, SCAIF was used for revision surgery after a free flap failure. The indications for flap use have been defects due to resection of stage II-IV cancer in the head and neck region. The operative site, time, complications and functional outcomes were assessed.

We identified 15 patients with a total of 16 SCAIF. One patient had received bilateral SCAIF. Out of the patients, 10 were men and 5 were women. Head and neck oncologic patients underwent tumor resection followed by immediate reconstruction using SCAIF. Among those 15 patients, 10 received previous radiotherapy in the head and neck region. All the patients had undergone multiple surgical procedures. Mean flap dimensions were 6.0cm (range, 5-7cm) wide and 22.0cm (range, 14-26cm) long. The proximal part of the flap was de-epithelialized to match the defect, resulting in a mean skin paddle length of 8.0cm (range, 5-12cm). After an average follow-up duration of 13 months (range 3-20 months), the flap survival rate was 90%. Two patients had had a partial loss of the flap. All the flaps were harvested in less than one hour. The donor sites were closed primarily and did not require any additional surgery. No donor site wound dehiscence had been reported. No infection or cellulitis were observed. None of the patients reported any functional donor site morbidity.

The supraclavicular flap provides a safe option for head and neck reconstruction of oncologic defects when traditional free flap is not recommended. It is also an excellent alternative to radial forearm free flap (RFFF) in head and neck soft tissue reconstruction, especially in vessel-depleted neck.