Lee Sanghoon, Cho Hye-Min, Kim Jin-Kyu, Nam Woong
Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1, Yonsei-ro, Seodaemoon-gu, Seoul, 03722 Republic of Korea.
Maxillofac Plast Reconstr Surg. 2018 Oct 4;40(1):25. doi: 10.1186/s40902-018-0165-1. eCollection 2018 Dec.
Some of head and neck cancer patients are in compromised general condition after ablation surgery and chemoradiation therapy, which makes secondary free tissue transfer quite challenging. Elderly cancer patients also have some risk for microvascular surgery with lengthened general anesthesia. In those cases, the pedicled flap vascularized by supraclavicular artery could be considered as an alternative to free flap. Despite several authors have demonstrated the clinical reliability of supraclavicular artery island flap (SCAIF), to date, SCAIF has not been widely used among reconstructive surgeon. In this article, we clarified vascular flow pattern and introduce simple surgical technique of SCAIF with a literature review.
Three patients who had underwent previous neck surgery and adjuvant therapy received maxillofacial reconstruction using SCAIF. It required only a few landmarks, flap harvesting was carried out, and the elapsed time gradually decreased to 15 min with experiences. There were no remarkable morbidities in both donor and recipient sites.
SCAIF exhibited minimal anatomic variations and short learning curve of surgical techniques, which might be valuable reconstruction modality for beginning surgeon. And it can be beneficial option for the patients with vessel-depleted neck, medically compromised status for lengthened general anesthesia and failed free tissue transfer.
部分头颈癌患者在消融手术和放化疗后全身状况较差，这使得二期游离组织移植颇具挑战性。老年癌症患者接受延长全身麻醉的微血管手术也存在一定风险。在这些情况下，锁骨上动脉供血的带蒂皮瓣可被视为游离皮瓣的替代方案。尽管有多位作者已证明锁骨上动脉岛状皮瓣（SCAIF）的临床可靠性，但迄今为止，SCAIF在重建外科医生中尚未得到广泛应用。在本文中，我们阐明了血管血流模式，并介绍了SCAIF的简单手术技术，并进行文献综述。
3例曾接受颈部手术及辅助治疗的患者采用SCAIF进行颌面重建。该手术仅需几个解剖标志，即可切取皮瓣，随着经验积累，手术时间逐渐缩短至15分钟。供区和受区均未出现明显并发症。
SCAIF解剖变异极小，手术技术学习曲线短，对于初涉手术的医生而言可能是一种有价值的重建方式。对于颈部血管条件差、因延长全身麻醉而存在医学风险以及游离组织移植失败的患者，它可能是一个有益的选择。
