Potential Benefits from the Use of the Supraclavicular Artery Island Flap for Immediate Soft-Tissue Reconstruction Durin
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CLINICAL PAPER
Potential Benefits from the Use of the Supraclavicular Artery Island Flap for Immediate Soft-Tissue Reconstruction During the COVID-19 Pandemic Alexandra Thompson1 Iain Varley1
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Zia Khan1 • Alan Patterson1 • Kapil Java1
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Received: 30 May 2020 / Accepted: 18 August 2020 Ó The Association of Oral and Maxillofacial Surgeons of India 2020
Abstract Introduction The coronavirus disease 19 (COVID-19) pandemic has placed significant strains on healthcare resources including staff, theatre, high dependency and intensive care availability. Surgery remains the optimal treatment for the majority of oral malignancies, and primary reconstruction is often necessary to avoid significant morbidity as a result of ablative procedures. Description The supraclavicular artery island flap (SCAIF) is increasingly finding a place as an alternative to free flap reconstruction of soft-tissue defects and has several specific advantages when compared to use of a soft-tissue free flap during the COVID-19 pandemic. It can be used for a range of head and neck defects. Results We describe our experience with the SCAIF during the pandemic in five patients with a variety of tumour types and locations. All five patients had a successful outcome with none requiring further reconstruction and all had a functional swallow postoperatively, including a patient who underwent a total pharyngeal reconstruction with a SCAIF. & Alexandra Thompson [email protected] Zia Khan [email protected] Alan Patterson [email protected] Kapil Java [email protected] Iain Varley [email protected] 1
Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, England
Discussion The use of a SCAIF during the current COVID-19 pandemic has significant advantages and is a reliable alternative to a soft tissue free flap. Keywords COVID-19 Reconstruction Supraclavicular artery island flap Oncology
Introduction On 17 March 2020, the British Association of Head and Neck Oncologists published guidelines regarding head and neck oncology management during the COVID-19 pandemic [1]. These recommend that operative time, surgical personnel and use of intensive care resources should all be minimised where possible. This leaves the head and neck surgeon with a clear dilemma: resection of head and neck malignancy and optimal functional reconstruction is resource intensive, requiring long operating times, high numbers of theatre and surgical staff and high-dependency post-operative care. Microvascular reconstruction with free tissue transfer is also challenging while using recommended personal protective equipment (PPE) [2]. The postoperative course may be complicated by return to theatre for flap salvage or flap failure and secondary reconstruction. There is a requirement for post-operative respiratory or inotropic support, and an appreciable rate of medical complications such as hospital-acquired pneumonia [3]. If primary reconstruction is avoided, in order to minimise the duration of the initial surgery then any
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