Supraclavicular artery pedicled flap in reconstruction of pharyngocutaneous fitulas after total laryngectomy

Pabiszczak, Maciej; Banaszewski, Jacek; Pastusiak, Tomasz; Szyfter, Witold

doi:10.5604/00306657.1147032

Cited by 10 publications

(17 citation statements)

References 15 publications

(23 reference statements)

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“…For tracheostoma reconstructions, Chu et al 65 argued that the SCF should be a first-line choice compared with other pedicled flaps such as the pectoralis major myocutaneous flap or the deltopectoral flap. These flaps are bulky and could narrow the airway stoma and hinder speech rehabilitation by preventing the insertion of a prosthetic devices 57,65 . Using the PMMF for oral reconstruction may even require segmental mandibulectomy to accommodate flap mass, however, even with this modification, patients may still experience compression 52 …”

Section: Resultsmentioning

confidence: 99%

A Comprehensive Review on the Supraclavicular Flap for Head and Neck Reconstruction

et al. 2022

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The supraclavicular artery flap (SCF) is a highly vascularized fasciocutaneous flap overlying the shoulder. The flap was first described in 1979 by Lamberty but did not gain popularity until much later due to lack of a reliable technique. The main advantages of using the SCF include avoiding microsurgical techniques, requiring only a single-stage operation, shorter operative time compared with alternative options, and a wider patient population including those with comorbidities who may be excluded from more extensive operations including free flaps surgeries. The SCF has been successfully performed on individuals with advanced age, poor nutrition, cachexia, obesity, diabetes, tobacco use, severe chronic obstructive pulmonary disease, hypertension, coronary artery disease, peripheral vascular disease, supraventricular tachycardia, atrial fibrillation, heart failure, asthma, and steroid use. The largest disadvantages of the SCF include the possibility of distal tip necrosis, size limitation without pre-expansion, and a moderately visible donor site scar. The following review and meta-analysis of the SCF details its use historically as both an island and a pedicle flap, and its application in head and neck reconstruction.

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Section: Resultsmentioning

confidence: 99%

A Comprehensive Review on the Supraclavicular Flap for Head and Neck Reconstruction

et al. 2022

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“…14 In another study of six patients reconstructed with the SCAIF for repair of pharyngocutaneous fistulae after laryngectomy, one patient experienced complete flap necrosis, and one had a recurrent fistula. 15 In contrast, two different studies examining a total of nine patients with oropharyngeal defects reported no flap loss in the postoperative period. 16,17 In contrast to our findings and selected reports in the literature, many authors have reported good success with the supraclavicular island flap for mucosal reconstruction.…”

Section: Discussionmentioning

confidence: 96%

Supraclavicular Flap Reconstruction of Cutaneous Defects Has Lower Complication Rate than Mucosal Defects

Kadakia

Agarwal

Mourad

et al. 2017

J reconstr Microsurg

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The objective of this study was to determine whether there was a difference in complication rate between cutaneous and mucosal defects reconstructed with the supraclavicular artery flap. Retrospective review of postoperative complications in 63 patients from 2008 to 2015 with cutaneous and mucosal head and neck defects following oncologic ablation reconstructed with the supraclavicular flap, with a minimum follow-up duration of 6 months. Of the 63 patients, 38 patients had cutaneous defects, whereas 25 had mucosal defects. Patients were followed up postoperatively to determine the presence of wound infection, partial flap necrosis, complete flap necrosis, and fistula formation. Complications in both defect groups as well as a statistical comparison of total complications were analyzed. Patients with cutaneous defects reconstructed with the supraclavicular flap had significantly lower postoperative complications than those with mucosal defects ( = 0.002). Flap necrosis, both partial and complete, was also lower in this same group ( = 0.0052). The supraclavicular artery flap may be a more suitable option for patients with cutaneous defects, given the reliability and lower propensity for postoperative complications The level of evidence is 4.

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“…Many authors suggest that reinforcing the pharyngeal suture with wellvascularized tissue will help to reduce the incidence of PCF formation in these patients (5,29,30). The pectoralis major myofascial flap is one of the most reliable flaps, but many other reconstructive options are described (supraclavicular artery island flap, fasciocutaneous free flaps, mammary artery perforator propeller flap, latissimus dorsi flaps, and facial artery-based cutaneous island flap) (21,22,(31)(32)(33)(34).…”

Section: Discussionmentioning

confidence: 99%

“Fistula Zero” Project After Total Laryngectomy: The Candiolo Cancer Institute Experience

et al. 2021

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ObjectivesPharyngocutaneous fistula (PCF) is a troublesome complication after total laryngectomy. The “Fistula zero” project aims to reduce the number of PCF by following a detailed protocol based on three fundamental key points.Materials and MethodsThe Fistula zero project included 77 patients who underwent total laryngectomy in the period from January 2019 to December 2020. The protocol consisted of three main aspects: the systematic placement of a Har-El salivary bypass tube, the continuous horizontal watertight pharyngeal suture using a barbed suture, onlay insetting of a pedicled flap in pre-treated patients.ResultsOne case of PCF (1.3%) and three small blind fistulas (3.9%) were observed in this series. The mean length of hospitalization was 18 days.ConclusionPharyngocutaneous fistula (PCF) prolongs hospitalization and delays adjuvant treatments. Thanks to a strict adherence to the protocol, it was possible to reduce PCF rates, avoiding lengthy hospitalization and additional surgical procedures.

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Supraclavicular artery pedicled flap in reconstruction of pharyngocutaneous fitulas after total laryngectomy

Cited by 10 publications

References 15 publications

A Comprehensive Review on the Supraclavicular Flap for Head and Neck Reconstruction

A Comprehensive Review on the Supraclavicular Flap for Head and Neck Reconstruction

Supraclavicular Flap Reconstruction of Cutaneous Defects Has Lower Complication Rate than Mucosal Defects

“Fistula Zero” Project After Total Laryngectomy: The Candiolo Cancer Institute Experience

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