JAMA Otol Logo Orlando 2013 AHNS Meeting Location
American Head & Neck Society
Annual Meeting, April 10-11, 2013
JW Marriott Grande Lakes
Orlando, Florida

During the
Combined Otolaryngology Spring Meeting
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Presentation: S005
Topic: Clinical - Plastic & Reconstructive Surgery
Type: Oral Presentation
Date: Wednesday, April 10, 2013
Session: 01:30 PM - 02:30 PM Reconstruction / Oropharynx / HPV
Authors: Niels Kokot, MD, Grace Peng, MD, Kashif Mazhar, MD, Lindsay Reder, MD, Uttam K Sinha, MD
Institution(s): Keck School of Medicine, University of Southern California

Objective: Free tissue transfer has become the standard of care for head and neck reconstruction in academic medical centers. The radial forearm free flap (RFFF) and anterolateral thigh (ALT) free flap are two workhorse flaps for soft tissue reconstruction. The supraclavicular artery island (SAI) flap is a local rotational flap that has been described as an alternative to free tissue transfer in head and neck reconstruction. We previously presented our initial experience using the SAI flap. The purpose of this study is to present our currently larger experience using the SAI flap, including some of its limitations.

Methods: Retrospective chart review of our first 45 consecutive patients who underwent reconstruction with SAI flap following head and neck oncologic surgery was done, after obtaining IRB approval. Information on prior treatment, size and location of defect, time required to raise the flap, time to de-epithelialize the flap, flap viability, donor site morbidity, and complications was collected. All statistical analysis was done using SAS 9.1.

Results: 38 out of 45 patients underwent ablative surgery for head and neck carcinoma and had a SAI flap performed as their soft tissue reconstruction, while 7 patients had a SAI flap for reconstruction of a non-cancer related defect. Defects of the oral cavity (n=13), oropharynx (n=7), laryngopharynx (n=8), esophagus (n=1), trachea (n=1), temporal bone (n=5), and cervical skin (n=10) were reconstructed. Mean flap width was 6.1cm (range 5-9cm), allowing for primary closure in all cases. Mean flap length was 21.4cm (range 15-28cm), with the proximal portion of the flap de-epithelialized to match the defect resulting in a mean skin paddle length of 7.91 cm (range 5-15cm). Mean harvest time was 34.9 minutes (range 17-60 min), and mean time for de-epithelialization was 15.2 minutes (range 5-40 min). Minor donor site dehiscence occurred in 6 patients (13.6%), while dehiscence requiring prolonged wound care occurred in 2 patients (4.5%). No patients reported severe limitations of arm movement. Partial skin flap necrosis occurred in 8 (17%) patients, while 2 (4%) patients had complete loss of the skin paddle. Salivary fistula developed in 7 (15.5%) patients, 4 of which healed spontaneously. A second reconstructive procedure using an alternate flap was required in 4 patients (9.1%). There were 6 patients (13.6%) with neck related complications. There was a significant correlation between flap length greater than 22 cm and flap necrosis (chi-sq p=0.01). No significant correlation between flap location or flap necrosis and fistula was found.

Conclusions: The SAI flap is a viable alternative to microvascular reconstruction of head and neck defect in select cases. This flap is fairly reliable, easy to harvest, and versatile. However, after initial success using this flap, we have determined that the SAI flap has limitation in length, with flaps longer than 22cm having a higher incidence of necrosis. Because it is a rotational flap, it is also limited in reconstructing some complex head and neck defects. As a result, we have become more selective in its application.

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