Investigation of risk factors on the final outcome of supraclavicular flap in the reconstruction of patients with head and neck surgery
Mojtaba Meybodian, Ebrahim Karimi, Saeed Sohrabpour
Introduction: Supraclavicular flap is one of the most widely used cases in the reconstruction of head and neck surgeries. However, despite its great importance, a comprehensive study of risk factors affecting its final survival has not been carried out. Therefore, the aim of this study was to investigate the effect of demographic factors, medical history and reconstructive surgery information on the incidence of these complications.
Implementation Method: In this case-series study, the medical records of 25 patients who underwent reconstruction of head and neck defects using supraclavicular flaps during August 2015 to August 2020 in Amir A'lam Hospital were reviewed. Information on demographic characteristics of patients (age and gender), medical history of patients (previous radiation therapy, previous head and neck surgery, smoking status, blood pressure, diabetes, hypothyroidism, type of pathology of the initial disease, harvest time) and site of reconstruction were recorded. Surgical information such as complications of the supraclavicular flap donor site, such as seroma and wound dehiscence, and the final flap status examined, including complete flap loss and partial necrosis, were investigated.
Results: According to our results, 32% of patients had diabetes and 60% had hypertension. Also, 44% smoked, 8% had a history of surgery, 16% had previous radiotherapy alone, and 4% had chemotherapy with radiotherapy. The site of reconstruction was 32% in the mouth, 24% in the parotid and 44% in the lateral cranial base (temporal). During the study, 20 patients (80%) survived the final uncomplicated supraclavicular flap, 5 patients (20%) had partial flap necrosis and no complete flap necrosis was seen. Also in this study, 4 patients (16%) had suture dehiscence at the flap donor site and no seroma was observed at the flap donor site. In addition, a significant relationship was observed between the incidence of wound dehiscence at the flap site and high blood pressure. Also, a significant relationship was observed between partial flap necrosis with hypertension and a history of radiotherapy.
Conclusion: Our results showed that hypertension and previous radiotherapy affect the final outcome, i.e. relative necrosis. Also, hypertension was significantly related to the wound dehiscence at the flap donor site.
Keywords: Supraclavicular Flap Reconstruction, Complications of Flap Donor Site Surgery, Final Outcome of Surgery, Necrosis