PURPOSE: Pharyngoesophageal oncologic resections produce complex reconstructive problems requiring reliable, robust flaps inorder to restore function. The goals of pharyngoesophageal reconstruction are to allow quick recovery, restore swallowing/speech, and withstand chemoradiation therapy. Both regional (deltopectoral, pectoralis, trapezius) and free (jejunum, forearm, anterolateral thigh, ileocolon) flaps have been successfully used to reconstruct these complex defects. In this study, we report the utility of the supraclavicular artery island (SAI) flap, a new regional fasciocutaneous flap option, in reconstructing partial and circumferential pharyngeal defects.
METHODS: Partial and circumferential pharyngeal oncological defects were reconstructed with pedicled SAI flaps. Complications and functional outcomes were assessed.
RESULTS: Over a three year period (2006-2009), twenty (n=20) patients underwent oncologic pharyngeal (partial or complete circumferential) reconstruction using the SAI flap. The majority of patients (18/20) had previous failed chemoradiation therapy. Patients ranged from 38 to 80 years (average 68.3 years). The flaps ranged in size from 6X18 to 8X21 cm. All flaps were harvested in less than 1 hour; there were no flap losses. All donor sites were closed primarily and did not require surgical revision. Shoulder function abnormality was not observed. Early complications observed included one patient who developed shoulder wound dehiscence followed by cellulitis did not require surgical intervention. Interestingly, 4/20 (20%) patients noted referred sensation to the shoulder when swallowing food. 6/20 (30%) patients developed early pharyngeal leaks, but all cases resolved on their own. 16/20 (80%) patients were able to perform PO intake after 3 months. Anastomotic strictures were noted in 2/20 (10%), and were successfully treated with ballooned dilatation by a gastroenterologist. Electrolaryngeal speech could be performed by all patients. Trans-esophageal puncture was also offered to all patients, and successfully surgically performed by puncturing the SAI flap with minimal complications. TEP speech was superior to electrolaryngeal speech as judged by patients and independent observers.
CONCLUSION: Supraclavicular artery island flap is a safe, reliable, easy-to-harvest, low morbidity, one-stage, sensate, fasciocutaneous regional flap option for reconstructing partial and circumferential pharyngoesophageal defects. Our early experience suggests that complications and functional outcomes are similar to other reported regional and free tissue transfer pharyngoesophageal reconstruction techniques. Additional technique-based comparative studies may be warranted.