Use of the Supraclavicular Artery Island Flap for Reconstruction of Cervico-facial Defects

Abstract

Objectives:

Describe the supraclavicular artery island (SAI) flap as an alternative flap for reconstruction of cervico-facial defects.

Methods:

Retrospective chart review in an academic, tertiary referral center of our first 18 consecutive patients undergoing SAI flap reconstruction for cervico-facial defects between 2010-2012. Outcome measures included size and location of the defect, time to raise the flap, flap size and viability, and complications. Statistical analysis was performed using SAS 9.1.

Results:

Defects of the temporal bone (n=5), and cervical skin (n=13) were reconstructed. Mean flap width was 6.1cm (range 5-9cm). Mean flap length was 21.7 cm (range 16-28cm), with the proximal portion of the flap de-epithelialized to match the defect resulting in a mean skin paddle length of 10.3 cm (range 5-18cm). Minor donor site dehiscence occurred in 2 patients. Partial skin flap necrosis occurred in 2 patients, while 1 patient had complete loss of the skin paddle. There was a significant correlation between flap length greater than 22 cm and flap necrosis (chi-sq p=0.01). No significant correlation between flap location and flap necrosis or dehiscence was found. 17 patients were happy with the cosmetic outcome of the flap.

Conclusions:

The SAI flap is a viable alternative to microvascular reconstruction of cervico-facial defects in select cases. This flap is reliable, easy to harvest, and versatile. It provides a good color match in the region. Flap complications and donor site morbidity were minimal and resolve with conservative measures. Flaps longer than 22 cm have a higher risk of skin necrosis.