Su Terry, Pirgousis Phillip, Fernandes Rui
Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL 32209, USA.
J Oral Maxillofac Surg. 2013 Mar;71(3):622-7. doi: 10.1016/j.joms.2012.07.005. Epub 2012 Aug 22.
The advent of microvascular free tissue transfer has given reconstructive surgeons a vast repertoire of treatment options for reconstruction of head and neck defects. However, the success of free flaps in head and neck reconstruction depends on the presence and quality of the recipient vessels in the neck for microvascular anastomosis. The supraclavicular artery island flap can be used to reconstruct a variety of head and neck defects, allowing the reconstructive surgeons to circumvent some of the problems inherent in vessel-depleted necks. The present study reports the use of the supraclavicular artery flap (SCAF) in the reconstruction of vessel-depleted neck and in difficult necks.
The present study was a retrospective study of patients who had undergone reconstruction with an SCAF and who also had a difficult neck or vessel-depleted neck in the head and neck surgery section from 2011 to 2012. Our inclusion criteria were patients treated at our institution with an SCAF who also had undergone multiple previous neck surgeries or patients with severely restricted donor options for soft tissue reconstruction. We excluded any patient for whom we did not have adequate follow-up or if the flap procedure was not performed by the faculty of the head and neck section.
We identified 8 patients with a total of 9 SCAFs. One patient received bilateral SCAFs. Of the 8 patients, 6 were men and 2 were women. With the exception of 1 patient, all had received previous radiotherapy to the head and neck region. All the patients had undergone multiple surgical procedures. The flap survival was 100%. However, 2 patients had partial loss of the flap, and 2 had partial donor site wound dehiscence. Our overall complication rate was 38%, including dehiscence of the flap and partial loss of the flap.
The SCAF is a sound option for reconstructing defects in the head and neck region in patients with previous radiotherapy and in multiple neck surgeries. The surgeon and patient should be aware of the high incidence of complications associated with this reconstructive option.
微血管游离组织移植的出现为重建外科医生提供了大量用于头颈部缺损重建的治疗选择。然而，游离皮瓣在头颈部重建中的成功取决于颈部用于微血管吻合的受区血管的存在情况和质量。锁骨上动脉岛状皮瓣可用于重建各种头颈部缺损，使重建外科医生能够规避颈部血管缺失所固有的一些问题。本研究报告了锁骨上动脉皮瓣（SCAF）在血管缺失颈部和复杂颈部重建中的应用。
本研究是一项回顾性研究，研究对象为2011年至2012年在头颈外科接受SCAF重建且颈部复杂或血管缺失的患者。我们的纳入标准是在本机构接受SCAF治疗且之前接受过多次颈部手术的患者，或软组织重建供区选择严重受限的患者。我们排除了任何随访不充分的患者，或皮瓣手术不是由头颈科医生进行的患者。
我们确定了8例患者，共使用了9个SCAF。1例患者接受了双侧SCAF。8例患者中，6例为男性，2例为女性。除1例患者外，所有患者之前均接受过头颈部放疗。所有患者均接受过多次外科手术。皮瓣存活率为100%。然而，2例患者皮瓣部分坏死，2例患者供区伤口部分裂开。我们的总体并发症发生率为38%，包括皮瓣裂开和皮瓣部分坏死。
对于之前接受过放疗且接受过多次颈部手术的患者，SCAF是重建头颈部缺损的合理选择。外科医生和患者应意识到这种重建方式相关并发症的高发生率。
