Experience of using a supraclavicular flap in reconstruction of oral cavity defects

Cover Page

Cite item

Full Text

Abstract

Introduction. In case of cancer of the oral mucosa at the first stage, the standard treatment approach is radical surgical intervention, with the formation of extensive defects leading to aesthetic and functional disorders. Taking into account the characteristics of defects, choosing a flap is a difficult task. Currently, there is a wide selection of regional and microvascular free flaps. However, not all flaps meet the requirements. The supraclavicular fasciocutaneous flap, being a regional flap, has a number of advantages: easy to harvest, reliable due to the constancy of the vascular pedicle, primary closure of the donor site, scarcity of hair, the possibility of closing various defects of the oral cavity.

 Aim. To evaluate the possibility of using a supraclavicular flap in patients with oral cancer to restore the defects after surgical treatment.

Materials and methods. The study included 10 patients with malignant tumors of the oral cavity who underwent surgical intervention with defect replacement using supraclavicular flap at the N. N. Blokhin National Medical Research Center of Oncology between February of 2015 and May of 2021. In 4 cases, buccal mucosa was affected; in 3 cases, the retromolar area; in 1 case, oral floor mucosa; in 1 case, mandibular alveolar ridge; in 1 case, mobile tongue. Flap sizes were 5–10 × 5–8 cm. Three (3) patients had history of radiotherapy, and 1 of them had a radical dose.

Results. In 4 patients without previous radiotherapy, partial flap necrosis was observed. In 1 patient, sutural diastasis in the oral cavity after partial flap necrosis was diagnosed. There were no cases of total flap necrosis and fistula formation. Suture dehiscence in the donor bed was observed in 1 patient only.

Conclusion. Use of supraclavicular flap is an option for oral cavity defect replacement after surgical intervention in patients with malignant tumors of the oral cavity producing satisfactory esthetic and functional results. The advantages of this flap are simple flap dissection, reliability of vascular pedicle, flexibility, possibility of replacing large defects, scant hair coverage.

About the authors

M. T. Berdigylyjov

N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia

Author for correspondence.
Email: mergen1992@gmail.com
ORCID iD: 0000-0002-6646-8728

Mergen Tuvakklychevich Berdigylyjov

24 Kashirskoe Shosse, Moscow 115478

Russian Federation

I. A. Zaderenko

N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia; Peoples’ Friendship University of Russia

Email: fake@neicon.ru
ORCID iD: 0000-0003-0183-4827

24 Kashirskoe Shosse, Moscow 115478

6 Miklukho-Maklaya St., Moscow 117198

Russian Federation

M. A. Kropotov

N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia

Email: fake@neicon.ru
ORCID iD: 0000-0002-9132-3416

24 Kashirskoe Shosse, Moscow 115478

Russian Federation

S. B. Aliyeva

N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia

Email: fake@neicon.ru
ORCID iD: 0000-0002-6835-5567

24 Kashirskoe Shosse, Moscow 115478

Russian Federation

D. K. Stelmakh

N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia

Email: fake@neicon.ru
ORCID iD: 0000-0002-6178-2777

24 Kashirskoe Shosse, Moscow 115478

Russian Federation

V. Z. Dobrokhotova

N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia

Email: fake@neicon.ru
ORCID iD: 0000-0001-5889-392X

24 Kashirskoe Shosse, Moscow 115478

Bld. 2, 8 Trubetskaya St., Moscow 119991

Russian Federation

G. Sh. Berdigylyjova

Peoples’ Friendship University of Russia

Email: fake@neicon.ru
ORCID iD: 0000-0002-0141-6353

6 Miklukho-Maklaya St., Moscow 117198

Russian Federation

References

  1. Shah J.P., Patel S.G., Singh B., Richard J.W. Head and Neck Surgery and Oncology. Elsevier; 2020. Available at: https://www.elsevier.com/books/jatin-shahs-head-and-neck-surgery-and-oncology/shah/978-0-323-41518-7
  2. Malignant neoplasms in Russia in 2020 (morbidity and mortality). Ed. by A.D. Kaprin, V.V. Starinsky, A.O. Shakhzadova. Moscow: P.A. Herzen Moscow State Medical Research Institute – branch of the Federal State Budgetary Institution “NMIC of Radiology” of the Ministry of Health of Russia, 2021. 252 p. (In Russ.).
  3. The state of oncological care to the population of Russia in 2021. Ed. by A.D. Kaprin, V.V. Starinsky, A.O. Shakhzadova. Moscow: P.A. Herzen Moscow State Medical Research Institute – branch of the Federal State Budgetary Institution “NMIC of Radiology” of the Ministry of Health of Russia, 2021. 239 p. (In Russ.).
  4. Malignant tumors. Practical recommendations of the Russian Society of Clinical Oncology. Available at: https://rosoncoweb.ru/standarts/RUSSCO/. (In Russ.).
  5. Kulbakin D.E., Choinzonov E.L., Mukhamedov M.R. et al. Postoperative complications of reconstructive and reconstructive operations in patients with head and neck tumors. Sibirskij onkologičeskij žurnal = Siberian Journal of Oncology 2021;20(1):53–61. (In Russ.).
  6. Saprinа O.A., Azizyan R.I., Lomaya M.V. Supraclavicular flap in the reconstruction of defects of the head and neck (literature review). Opukholi golovy i shei = Head and Neck Tumors 2017; 7(1):46–9. (In Russ.). doi: 10.17650/2222-1468-2017-7-1-46-49
  7. Mahieu R., Colletti G., Bonomo P. et al. Head and neck reconstruction with pedicled flaps in the free flap era. Acta Otorhinolaryngol Ital 2016;36(6):459–68. doi: 10.14639/0392-100X-1153
  8. Kazanjian V.H., Converse J. The surgical treatment of facial injuries. Baltimore: Williams & Wilkins, 1949.
  9. Kirschbaum S. Mentosternal contracture; preferred treatment by acromial (in charretera) flap. Plast Reconstr Surg Transplant Bull 1958;21(2):131–8.
  10. Lamberty B.G. The supra-clavicular axial patterned flap. Br J Plast Surg 1979;32(3):207–12. doi: 10.1016/s0007-1226(79)90033-x
  11. Di Benedetto G., Aquinati A., Pierangeli M. et al. From the ”charretera” to the supraclavicular fascial island flap: revisitation and further evolution of a controversial flap. Plast Reconstr Surg 2005;115(1):70–6.
  12. 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; discussion 852–4. doi: 10.1097/00006534-200003000-00003
  13. Pallua N., von Heimburg D. Pre-expanded ultrathin supraclavicular flaps for (full-) face reconstruction with reduced donor-site morbidity and without the need for microsurgery. Plast Reconstr Surg 2005;115(7):1837–44; discussion 1845–7. doi: 10.1097/01.prs.0000165080.70891.88
  14. Granzow J.W., Suliman A., Roostaeian J. et al. The supraclavicular artery island flap (SCAIF) for head and neck reconstruction: surgical technique and refinements. Otolaryngol Head Neck Surg 2013;148(6):933–40. doi: 10.1177/0194599813484288
  15. Ramirez C.A., Fernandes R.P. The supraclavicular artery island and trapezius myocutaneous flaps in head and neck reconstruction. Oral Maxillofac Surg Clin North Am 2014;26(3):411–20. doi: 10.1016/j.coms.2014.05.009
  16. Ma X., Zheng Y., Xia W. et al. An anatomical study with clinical application of one branch of the supraclavicular artery. Clin Anat 2009;22(2):215–20. doi: 10.1002/ca.20742
  17. Trautman J., Gore S., Potter M. et al. Supraclavicular flap repair in the free flap era. ANZ J Surg 2018;88(6):540–6. doi: 10.1111/ans.14263
  18. Su T., Pirgousis P., Fernandes R. Versatility of supraclavicular artery island flap in head and neck reconstruction of vessel-depleted and difficult necks. J Oral Maxillofac Surg 2013;71(3):622–7. doi: 10.1016/j.joms.2012.07.005
  19. Herr M.W., Emerick K.S., Deschler D.G. The supraclavicular artery flap for head and neck reconstruction. JAMA Facial Plast Surg 2014;16(2):127–32. doi: 10.1001/jamafacial.2013.2170
  20. Rigby M.H., Hayden R.E. Regional flaps: a move to simpler reconstructive options in the head and neck. Curr Opin Otolaryngol Head Neck Surg 2014;22(5):401–6. doi: 10.1097/MOO.0000000000000090
  21. Chiu E.S., Liu P.H., Friedlander P.L. Supraclavicular artery island flap for head and neck oncologic reconstruction: indications, complications, and outcomes. Plast Reconstr Surg 2009;124(1):115–23. doi: 10.1097/PRS.0b013e3181aa0e5d
  22. Sandu K., Monnier P., Pasche P. Supraclavicular flap in head and neck reconstruction: experience in 50 consecutive patients. Eur Arch Otorhinolaryngol 2012;269(4):1261–7. doi: 10.1007/s00405-011-1754-0
  23. Kokot N., Mazhar K., Reder L.S. et al. The supraclavicular artery island flap in head and neck reconstruction: applications and limitations. JAMA Otolaryngol Head Neck Surg 2013;139(11):1247–55. doi: 10.1001/jamaoto.2013.5057
  24. Pabiszczak M., Banaszewski J., Pastusiak T., Szyfter W. Supraclavicular artery pedicled flap in reconstruction of pharyngocutaneous fitulas after total laryngectomy. Otolaryngol Pol 2015;69(2):9–13. doi: 10.5604/00306657.1147032
  25. Teixeira S., Costa J., Monteiro D. et al. Pharyngocutaneous and tracheoesophageal fistula closure using supraclavicular artery island flap. Eur Arch Otorhinolaryngol 2018;275(7):19216. doi: 10.1007/s00405-018-4961-0
  26. Fang S.L., Zhang D.M., Chen W.L. et al. Reconstruction of full-thickness cheek defects with a folded extended supraclavicular fasciocutaneous island flap following ablation of advanced oral cancer. J Cancer Res Ther 2016;12(2):888–91. doi: 10.4103/0973-1482.177497
  27. Chen W.L., Zhang D.M., Yang Z.H. et al. Functional hemitongue reconstruction using innervated supraclavicular fasciocutaneous island flaps with the cervical plexus and reinnervated supraclavicular fasciocutaneous island flaps with neurorrhaphy of the cervical plexus and lingual nerve. Head Neck 2014;36(1):66–70. doi: 10.1002/hed.23268
  28. Kokot N., Kim J.H., West J.D., Zhang P. Supraclavicular artery island flap: critical appraisal and comparison to alternate reconstruction. Laryngoscope 2022;132(3):1–14. doi: 10.1002/lary.28706
  29. Giordano L., Di Santo D., Occhini A. et al. Supraclavicular artery island flap (SCAIF): a rising opportunity for head and neck reconstruction. Eur Arch Otorhinolaryngol 2016;273(12):4403–12. doi: 10.1007/s00405-016-4092-4
  30. Kadakia S., Agarwal J., Mourad M. et al. Supraclavicular flap reconstruction of cutaneous defects has lower complication rate than mucosal defects. J Reconstr Microsurg 2017;33(4):275–80. doi: 10.1055/s-0036-1597718
  31. Zhang S., Chen W., Cao G., Dong Z. Pedicled supraclavicular artery island flap versus free radial forearm flap for tongue reconstruction following hemiglossectomy. J Craniofac Surg 2015;26(6):e527–30. doi: 10.1097/SCS.0000000000002031

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2022


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 36990 от  21.07.2009.