Supraclavicular Artery Island Flap as a Reliable Option for Pharyngoesophageal Reconstruction: Evidence from 30 Consecutive Cases
supraclavicular artery island flap; hypopharyngeal cancer; pharyngoesophageal reconstruction; swallowing function; pharyngocutaneous fistula
AuthorsAbstractBackground: This study aimed to evaluate the outcomes of the supraclavicular artery island flap (SAIF) reconstruction in patients with stage III–IV laryngeal and hypopharyngeal carcinoma, focusing on flap survival, swallowing function, complications, and survival. Methods: We conducted a prospective study of 30 consecutive male patients with stage III–IV squamous cell carcinoma of the larynx or hypopharynx treated at Ho Chi Minh City Oncology Hospital between January 2021 and September 2023. All underwent total laryngectomy with partial or total hypopharyngectomy, followed by immediate SAIF reconstruction. Primary endpoints were flap survival and swallowing function assessed by the MD Anderson Dysphagia Inventory (MDADI). Secondary endpoints included postoperative complications and overall survival. Results: All flaps survived without necrosis. The mean defect size was 63 cm², and flap dimensions averaged 20.6 × 7.0 cm. Pharyngocutaneous fistula occurred in 10%, seroma in 26.7%, and superficial donor site necrosis in 20%, all managed conservatively. At follow-up, 90% of patients resumed oral intake, with 81.5% tolerating a solid or soft diet; the mean MDADI score was 92. Mean overall survival was 19.6 months, with 1- and 2-year survival rates of 66.5% and 60.7%. Multivariate analysis confirmed pharyngocutaneous fistula as an independent predictor of poor survival (HR 5.98; p = 0.01). Conclusions: SAIF is a safe, reliable, and resource-appropriate option for pharyngoesophageal reconstruction, offering excellent flap survival, favorable swallowing outcomes, and acceptable morbidity.
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