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Original Article   

Otorhinolaryngology 2022 Jun 01

DOI: 10.23736/S2724-6302.22.02429-X

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

The role of the supraclavicular flap in salvage laryngectomy

Mohamed ZAHRAN 1 , Sundus ALSEDRA 1, Omar AHMED 1, Mohamed ZAKI 2, Ahmed YOUSSEF 1, 3

1 Department of Otolaryngology-Head and Neck Surgery, Alexandria University Hospital, Alexandria, Egypt; 2 Department of Human anatomy and Embryology, Alexandria University Hospital, Alexandria, Egypt; 3 Department of Otolaryngology-Head and Neck Surgery, Oklahoma Medical Center, Oklahoma, OK, USA


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BACKGROUND: In recent years, there has been a noticeable increase in the use of the larynx preservation chemoradiation (CRT) protocols. As a result, the rate of salvage laryngectomy has increased dramatically. Irradiated tissue that is insufficiently vascularized has a higher rate of wound dehiscence and fistula formation. Recent research has focused on using vascularized tissue out of an irradiated area to reinforce the irradiated neck and mitigate the sequence of fistulas, even if pharyngeal repair is not required. The supraclavicular flap (SCF) has secured its place in this sitting because of ease of harvest and lack of microsurgical expertise. The survival of the flap is equivalent to that of other pedicled or free flaps. The aim of the current work is to highlight the utility and versatility of SCF reconstruction in salvage laryngectomy sitting.
METHODS: Between April 2019 and October 2021, the study was performed at a tertiary head and neck cancer centre. This study includes retrospective data for a total of 14 salvage laryngectomy cases. In every patient, a salvage total laryngectomy with a SCF was performed. The SCF was used to repair a deficiency in the skin of the front neck or a defect in the pharyngeal mucosa.
RESULTS: The study comprised fourteen individuals who were candidates for salvage laryngectomy. The supraclavicular flap was utilized to reconstruct anterior cervical skin defect in eight patients. While, in six cases, it was used as a patch graft (to repair a mucosal defect in the anterior wall of neo-pharynx). All of the patients' flaps were viable, and no total flap loss was recorded. Limited distal flap necrosis occurred in one case in whom the flap was used for cervical skin reconstruction. The patient responded well to conservative local care. The donor site was closed directly and no skin graft was necessary.
CONCLUSIONS: The supraclavicular flap has proven to be a versatile flap that is simple to harvest and has little donor site morbidity.


KEY WORDS: Supraclavicular artery island flap; Fasciocutaneous flap; Head and neck cancer; Reconstructive surgery

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