Supraclavicular Artery Flap for Head and Neck Oncologic Reconstruction: An Emerging Alternative

Aim. Head and Neck oncologic resections often leave complex defects which are challenging to reconstruct. The need of the hour is a versatile flap which has the advantages of both a regional flap (viz. reliable and easy to harvest) and a free flap (thin, pliable with good colour match). In this a study we assessed the usefulness of the supraclavicular artery flap in head and neck oncologic defects. Materials and Method. The flap was used as a pedicled fasciocutanous and was based on the transverse supraclavicular artery. We assessed this reconstructive option for complications as well as its and functional out comes. Results. Eleven cases underwent supraclavicular artery flap between 20011-2012 of which 5 were males and 6 females. Mean defect size was 5？cm × 6？cm. Nine donor sites were closed primarily and 1 required split skin grafting. We encountered one complete flap loss which was attributed to a band of constricting skin bridge over the vascular pedicle in a defect involving lateral third of midface. Two patient developed pharyngeocutaneous fistula (without flap loss) out of 3 patients who underwent augmentation pharyngoplasty post Near total laryngectomy. Conclusion. Supra clavicular artery flap is a thin versatile, reliable, easy to harvest, with good cosmetic and functional outcome at both ends (recipient and donor) for reconstructing head and neck oncologic defects. 1. Introduction Head and neck oncologic resections leave complex defects which are challenging to reconstruct. The various reconstructive options available for resurfacing of this region range from split thickness skin grafts and ultrathin flaps to local or free flaps. In the facial region, one has to take account of the aesthetic units and provide an appropriately thin flap to restore both form and function. The color and texture match is also equally important. A locoregional flap should also leave a minimum of donor site morbidity and preferably be hidden beneath the clothing. According to Gillies’ concept, the more adjacent the donor site is, the better the skin will match the recipient site (1). Regional muscle flaps namely pectoralis major myocutaneous flap owing to its bulk is difficult to handle and inset into a 3 diemensional defect; additionally in females the bulk due to breast tissue complicates intraoperative handling and insetting. Further the resultant breast deformity is a source of concern to young women. In males this is a relatively less hairy zone than the anterior chest in males and can therefore be exploited for interior mucosal lining. Free flaps need special