Supraclavicular artery island flap for head and neck reconstruction: Our experience and exploratory analysis of risk factors.
TL;DR
SCAIF is a reliable and versatile reconstructive option for oncologic head and neck defects, including in previously operated or irradiated necks, but caution is warranted particularly in patients with diabetes or vascular disease, as vascular comorbidities appear to be more clinically precise risk factors than chronological age alone.
Abstract
Objective
The supraclavicular artery island flap (SCAIF) is being increasingly used for reconstruction of complex head and neck defects as an alternative to the traditional free flap or pedicled pectoralis flap. Here, we describe our experience with SCAIF for oncologic head and neck reconstruction and aim to identify patient factors associated with flap complications.
Methods
A retrospective review of patients who underwent SCAIF reconstruction at a tertiary academic center was conducted between 2015 and 2023 (n=23). Collected variables included patient characteristics, operative parameters, and postoperative outcomes.
Results
The mean patient age was 70.2 years. Six patients had a history of prior radiation, and 6 underwent ipsilateral neck dissection. Twelve patients received adjuvant radiation following flap transfer. Minor flap-related complications included delayed wound healing (n = 3) and partial flap necrosis (n = 6). One patient experienced total flap necrosis. Systemic complications included myocardial infarction (n = 2), pulmonary embolism (n = 1), atrial fibrillation (n = 1), and deep vein thrombosis (n = 1). Advanced age was associated with recipient-site complications (p = 0.018). Elevated body mass index was associated with systemic complications, longer ICU stays, and increased total hospital length of stay (p=0.036, p = 0.008, and p = 0.001, respectively). History of vascular disease and diabetes mellitus were associated with flap necrosis and delayed wound healing, respectively (p=0.025 and p=0.004). Longer operative time was associated with flap dehiscence (p=0.002).
Conclusion
SCAIF is a reliable and versatile reconstructive option for oncologic head and neck defects, including in previously operated or irradiated necks. Caution is warranted particularly in patients with diabetes or vascular disease, as vascular comorbidities appear to be more clinically precise risk factors than chronological age alone. Elevated body mass index also warrants consideration.