Citation: | GUAN Yue, HU Guohua, WANG Zhihai, et al. Clinical analysis of diversity of defect repair with supraclavicular island flap after head and neck tumor surgery[J]. J Clin Otorhinolaryngol Head Neck Surg, 2023, 37(12): 1005-1010. doi: 10.13201/j.issn.2096-7993.2023.12.016 |
To investigate the diversity and clinical effect of supraclavicular island flap in repairing the defect after head and neck tumor surgery.
A retrospective analysis was performed on 30 patients who received the repair of head and neck defects with supraclavicular island flaps at Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Chongqing Medical University from January 2017 to March 2023. The sites and types of defects, intraoperative blood loss, time of flaps preparation, areas of flaps, survival of the flaps and other complications were recorded.
A total of 30 patients were enrolled, including 26 males and 4 females, aged 36-82 years. Among them, 22 patients with hypopharyngeal partial defect were repaired (19 patients with ipsilateral defect and 3 patients with contralateral defect). In addition, 2 patients were repaired with contralateral pectoralis major musculocutaneous flap around the hypopharynx, the neck skin defect was repaired in 2 patients, the parotid skin defect was repaired in 2 patients, the temporal bone skin defect was repaired in 1 patient, and the cervical esophageal defect was repaired in 1 patient. The average blood loss during the operation was 8 ml, and the average time was 32 min. The flap areas ranged from 5.0 cm×4.0 cm to 20.0 cm×8.0 cm. 27 of 30 flaps survived(90.0%), and pharyngeal fistula occurred in 6 patients after operation(4 flaps survived after local dressing). One patient was complicated with venous thrombosis(the flap necrosis after local dressing). Shoulder and neck functions(lift, internal rotation and abduction) were not significantly affected in 29 patients, and the function of 1 patient with shoulder infection was not affected after treatment.
Supraclavicular island flap is a highly vascularized axial fascial flap. It is easy to make, thin, and soft in texture, and can be used to repair different sites and types of postoperative head and neck tumor defects with a low donor site complication rate. Good results in post-operative repair of head and neck tumors are worth promoting.
[1] | Hamidian Jahormi A, Horen SR, Miller EJ, et al. A Comprehensive Review on the Supraclavicular Flap for Head and Neck Reconstruction[J]. Ann Plast Surg, 2022, 88(6): e20-e32. doi: 10.1097/SAP.0000000000003098 |
[2] | de Carvalho FM, Correia B, Silva Á, et al. Versatility of the Supraclavicular Flap in Head and Neck Reconstruction[J]. Eplasty, 2020, 20: e7. |
[3] | Emerick KS, Herr MA, Deschler DG. Supraclavicular flap reconstruction following total laryngectomy[J]. Laryngoscope, 2014, 124(8): 1777-17782. doi: 10.1002/lary.24530 |
[4] | 展望, 徐杰, 蔡用清, 等. 颈横动脉为蒂斜方肌肌皮瓣的应用解剖[J]. 医学信息, 2006, 20(3): 467-469. doi: 10.3969/j.issn.1006-1959.2006.03.049 |
[5] | Atallah A, Guth A, Chabolle F, et al. Supraclavicular artery island flap in head and neck reconstruction[J]. European annals of otorhinolaryngology, head and neck diseases, 2015, 132(5): 291-294. doi: 10.1016/j.anorl.2015.08.021 |
[6] | 陈建武, 马显杰, 郭树忠. 以颈横动脉分支为蒂的锁骨上皮瓣和颈段皮支皮瓣的区别与联系[J]. 中华整形外科杂志, 2018, 34(3): 239-242. |
[7] | Pallua N, Wolter TP. Defect classification and reconstruction algorithm for patients with tracheostomy using the tunneled supraclavicular artery island flap[J]. Langenbecks Arch Surg, 2010, 395(8): 1115-1119. doi: 10.1007/s00423-010-0654-x |
[8] | Chiu ES, Liu PH, Friedlander PL. Supraclavicular artery island flap for head and neck oncologic reconstruction: indications, complications, and outcomes[J]. Plast Reconstr Surg, 2009, 124(1): 115-123. doi: 10.1097/PRS.0b013e3181aa0e5d |
[9] | Nthumba PM. The supraclavicular artery flap: a versatile flap for neck and orofacial reconstruction[J]. J Oral Maxillofac Surg, 2012, 70(8): 1997-2004. doi: 10.1016/j.joms.2011.08.043 |
[10] | Epps MT, Cannon CL, Wright MJ, et al. Aesthetic restoration of parotidectomy contour deformity using the supraclavicular artery island flap[J]. Plast Reconstr Surg, 2011, 127(5): 1925-1931. doi: 10.1097/PRS.0b013e31820cf40a |
[11] | Chen WL, Zhang DM, Yang ZH, et al. Extended supraclavicular fasciocutaneous island flap based on the transverse cervical artery for head and neck reconstruction after cancer ablation[J]. J Oral Maxillofac Surg, 2010, 68(10): 2422-2430. doi: 10.1016/j.joms.2010.01.015 |
[12] | Muangsiri P, Tanjapatkul R, Sriswadpong P, et al. Indocyanine Green Fluorescence Angiography of the Transverse Cervical Arterial Supply to Clavicle Flaps: An Anatomical Study[J]. Otolaryngol Head Neck Surg, 2022, 166(1): 68-73. doi: 10.1177/01945998211000432 |
[13] | West JD, Kharidia K, Kim J, et al. Use of ICG Angiography in Head and Neck Reconstruction With the Supraclavicular Artery Island Flap[J]. J Oral Maxillofac Surg, 2022, 80(8): 1424-1433. doi: 10.1016/j.joms.2022.04.011 |
[14] | Kokot N, Mazhar K, Reder LS, et al. The supraclavicular artery island flap in head and neck reconstruction: applications and limitations[J]. JAMA Otolaryngol Head Neck Surg, 2013, 139(11): 1247-1255. doi: 10.1001/jamaoto.2013.5057 |
[15] | 刘宏伟, 张文谦, 路铁, 等. 锁骨上动脉岛状皮瓣在下咽癌手术修复重建中的应用[J]. 中国美容整形外科杂志, 2022, 33(8): 496-498. |
[16] | 朱小龙. 喉癌及下咽癌全喉切除术后并发咽瘘的相关因素临床分析[J]. 中国医学工程, 2014, 22(10): 23-28. |
[17] | 钟美琦, 郭良, 楼建林, 等. 锁骨上岛状皮瓣在头颈部肿瘤手术缺损修复中的应用分析[J]. 中国耳鼻咽喉头颈外科, 2022, 29(10): 617-621. |
[18] | 张彬, 鄢丹桂, 张亚冰, 等. 锁骨上岛状皮瓣修复头颈肿瘤手术缺损临床初步研究[J]. 中华耳鼻咽喉头颈外科杂志, 2015, 50(6): 468-472. doi: 10.3760/cma.j.issn.1673-0860.2015.06.007 |
[19] | 周晶, 陈晓红, 金永钢, 等. 锁骨上皮瓣修复头颈部缺损术后肩功能评估[J]. 中华耳鼻咽喉头颈外科杂志, 2021, 56(9): 919-924. |
[20] | 李正红, 张姬. 不同游离组织皮瓣移植修复口腔颌面部恶性肿瘤切除术后组织缺损的效果[J]. 医学信息, 2019, 32(19): 99-101. |