Clinical cases of using a supraclavicular flap for closure of a circular defect of the pharynx and cervical esophagus

Defects after laryngopharyngectomies create a complex esthetics and functional problem. In this article, we present clinical cases of using a supraclavicular island flap for closing defects after surgical treatment of neck tumors.

In the 1^st case, a female patient with poorly differentiated squamous-cell carcinoma of the laryngopharynx underwent modified radical neck dissection on the right, laryngopharyngectomy with pharyngeal reconstruction using a fasciocutaneous supraclavicular flap. In the postoperative period, marginal necrosis of the deltopectoral flap developed but it healed by secondary intention. Control X-ray of the esophagus with barium sulfate showed that the pharynx transplant was functioning, anastomosis with the esophagus was consistent.

In the 2^nd case, a male patient with cancer of the vestibular larynx underwent surgical (tracheostomy, laryngectomy, modified radical neck dissection) and radiation treatment. During follow-up monitoring, a parastomal recurrence was detected which was removed with trachea resection, circular resection of  the cervical esophagus, removal of  the  right lobe of  the  thyroid, and combined defect reconstruction using a  fasciocutaneous supraclavicular flap (circular esophageal defect) and a pectoralis major myocutaneous flap. Postoperative period was complications-free. Control X-ray showed transplant patency and anastomosis consistency.

Therefore, the use of a supraclavicular flap is one of possible variants for closure of circular pharyngeal and esophageal defects and an alter-native for free revascularized flaps in cases where they can’t be used.

1. Pallua N., Magnus Noah E. The tunneled supraclavicular island flap: an optimized technique for head and neck reconstruction. Plast Reconstr Surg 2000;105(3):842–51. DOI: 10.1097/00006534-200003000-00003. PMID: 10724241.

2. Atallah S., Guth A., Chabolle F., Bach C.-A. Supraclavicular artery island flap in head and neck reconstruction. Eur Ann Otorhinolaryngol Head Neck Dis 2015;132(5):291–4. DOI: 10.1016/j.anorl.2015.08.021. PMID: 26386616.

3. Patel R. S., Goldstein D. P., Brown D. et al. Circumferential pharyngeal reconstruction: history, critical analysis of techniques, and current therapeutic recommendations. Head Neck 2010;32(1):109–200. DOI: 10.1002/hed.21169. PMID: 19565471.

4. Hanasono M. M., Barnea Y., Skoracki R. J. Microvascular surgery in the previously operated and irradiated neck. Microsurgery 2009;29(1):1–7. DOI: 10.1002/micr.20560. PMID: 18942649.

5. Kazanjian V. H., Converse J. M. The surgical treatment of facial injuries. Baltimore: Williams & Wilkins, 1949. 574 p.

6. Lamberty B. G., Cormack G. C. Misconceptions regarding the cervico-humeral flap. Br J Plast Surg 1983;36(1):60–3. DOI: 10.1016/0007-1226(83)90013-9. PMID: 6821729.