Northeastern Society of Plastic Surgeons

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Supraclavicular Artery Island Flap for Head and Neck Reconstruction: Our Experience and Predictors of Complications
Joshua C. Hwang*1, Chloe Cottone2, William Magner3, Can Ozturk3, Cemile Ozturk3
1Surgery, SUNY Buffalo, Buffalo, NY; 2Jacobs School Of Medicine And Biomedical Sciences, Buffalo, NY; 3Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY


Purpose: Supraclavicular artery island flap (SCAIF) has recently reemerged as a versatile means of reconstruction for head and neck defects as an alternative to traditional free flaps or pedicled pectoralis flap. Its advantages include good color match, reduced flap bulk, minimal donor site morbidity, and short harvest time. Our study describes our experience with SCAIF and identifies comorbidities associated with major postoperative complications.
Methods: Retrospective review of twenty three patients at a tertiary oncologic cancer center. Patient demographics, comorbidities, surgical parameters, and postoperative outcomes were assessed.
Results: The mean age of patients in the study was 70.17 (range 44-92), with 16 males and 7 females. Average BMI was 28.74 (range 15-52.5). Mean length of admission was 7.43 days (range 2-37) and 1.74 days in the ICU (range 0-15). Average defect size was 75.98 cm 2 with flap area of 80.32 cm2 (range of 20-180 cm2). Average operative time including oncologic resection was 8.89 hrs (range 1.15-18.08 hrs).
One (4.35%) patient experienced total flap failure requiring a secondary flap reconstruction. Six (26.09%) patients had minor flap necrosis or delayed healing managed by local wound care. No patients experienced shoulder contracture, salivary leak, fistula, hematoma, or infection postoperatively. Mortality was seen in six patients (26.09%), all beyond 1 year post operation.
Adjuvant radiation was associated with greater postoperative complications overall. Patient history of diabetes, co-existing thrombotic complication (DVT, PE), were significantly associated with delayed wound healing at the flap. Older age and higher BMI were correlated with longer hospital and ICU stays.
Conclusion: SCAIF is reliable and safe for complex head and neck reconstruction, with a low rate of complications necessitating surgical revision. It represents an alternative reconstruction option for patients who are poor candidates for free flaps and does not require microsurgical experience.

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