Introduction : Defects caused by grade II and III osteoradionecrosis (ORN) present a difficult reconstructive problem. Often tissues are of poor quality and recipient vessels for free flap anastomosis can be sparse. After seemingly successful free tissue transfer wound dehiscence, and further ORN is a frequent problem. The supraclavicular artery flap (SCAF), a fasciocutaneous flap based on the supraclavicular artery, is gaining popularity in difficult reconstructive cases. The main advantages are its vessel reliability, ease of raising, good skin colour match and low donor site morbidity. We present a case series of SCAF in advanced ORN.
Methods : Retrospective analysis was undertaken of 12 consecutive SCAF cases performed by a single surgeon with high volume of ORN cases. Notes were analysed for type of ORN reconstruction, timing of SCAF reconstruction and complications related to the SCAF.
Results : Between 2011 and 2013, 12 SCAF operations were performed in 12 patients. Post ORN reconstruction had been carried out with composite fibula (10), radial forearm (1) and scapula flaps (1) Following SCAF reconstruction there were no complete losses of the flap. There were 2 cases of partial flap loss. In a further 2 cases there was dehiscence at the recipient site and in 3 cases at the donor site. All complications were managed conservatively and did not require return to theatre.
Conclusion : SCAF is a useful tool in the armamentarium of the reconstructive surgeon and should be considered in the reconstruction of ORN defects, particularly where previously free flap reconstruction has been complicated. Key words : Osteoradionecrosis; supraclavicular; flap; wound breakdown