| BackgroundPatients with advanced cancer of laryngeal cancer(LC)and hypopharyngeal carcinoma(HPC)have a very poor prognosis.Complete surgical removal of the primary cancer and regional lymph nodes is considered to be the most effective treatment for laryngeal cancer and hypopharyngeal carcinoma.However,the surgical approach for laryngeal cancer and hypopharyngeal carcinoma frequently results in disturbances of vocal and swallowing functions.Reconstruction of a defect after resection of the hypopharynx and cervical esophagus remains one of the greatest challenges to the head and neck surgeon.The ideal reconstruction would restore normal anatomy,allow for normal deglutition,speech and breathing.The reconstructive options may be:1)local tissues:primary closure and laryngeal flaps,skin grafts,cutaneous flaps:cervical and deltopectoral;2)myocutaneous flaps:pectoralis major,latissimus dorsi,and trapezius;3)visceral transposition:gastric pull-up(GPU)and jejunal free flaps(JFFs),and fasciocutaneous free flaps(FCFFs):radial forearm,lateral thigh,and scapula.The use of pedicled flaps for reconstruction of head and neck defects has been well described in the literature.More recently,the use of the supraclavicular fasciocutaneous flap has been described for the reconstruction of a variety of head and neck defects,including pharyngeal defects,oral cavity defects,parotid,lateral skull base,and cutaneous defects.The use of this flap has been shown to be well tolerated by the patient,with minimal donor site morbidity and with good viability at the recipient site.But the supraclavicular artery perforators and the location of choke-vessels among these perforators are unknown.In this study,the supraclavicular region perforators were studied in fresh cadavers.Cadavers were injected with lead oxide for three-dimension reconstruction.The origin,course,and distribution of the perforators in the supraclavicular region and shoulder area were comprehensively documented.The scans were subject to the Materialized Interactive Medical Image Controlling System(MIMICS)for 3D visualization and reconstruction.And we also evaluate the efficacy of the pedicled supraclavicular artery island flap(SAIF)for head and neck reconstruction of late-stage laryngeal cancer and hypopharyngeal carcinoma.Part ? Applied anatomy of the the supraclavicular artery flap with computed tomographic angiographyMethods1.The supraclavicular region perforators were studied in 15 fresh cadavers.Cadavers were injected with lead oxide for three-dimension reconstruction.The origin,course,and distribution of the perforators in the supraclavicular region and shoulder area were comprehensively documented.2.The scans were subject to the Materialized Interactive Medical Image Controlling System(MIMICS)for 3D visualization and reconstruction.Information of the transverse cervical artery perforators i.e.the number,anastomosis and perfusion areas of the perforators were obtained.3.Another 15 embalmed adult cadaver specimens were edissected to observe the supraclavicular artery perforators with diameter greater than 0.5 mm and measure their diameter,main course and anastomosis branches.Results1.The supraclavicular artery originates from transverse cervical artery.There were a lot of anastomosing branches between the supraclavicular artery perforators.2.There were 1.0±2.0 supraclavicular artery perforators in the supraclavicular region and shoulder area.The average external diameter was 1.2±0.20mm.Each perforator supplied an average area of(16.25±3.61)cm2.3.Extensive anastomoses were found between the ulnar artery perforators and multiple adjacent source arteries.Conclusions1.The number,position and course of the supraclavicular artery perforators are constant.2.There are a large number of perforator anastomosis branches which make it suitable to harvesting,which is ideal for upper extremity reconstruction,either as a proximally or distally based local perforator flap or as a free flap.3.This provides a new surgical option for harvesting over-sized flaps.Part ? Clinical experience of the supraclavicular flap used to reconstruct head and neck defects in late-stage laryngeal cancer and hypopharyngeal carcinomaMethods1.Reconstructive surgeries for head and neck oncologic defects were performed with musculi stemohyideus flap(MSHF)in 8 patients,gastric tube pull-up(GTP)in 7 patients,supraclavicular artery island flap(SAIF)in 6 patients,from 2012 to 2016,and the cases were review,respectively.2.The vocal and swallowing functions was evaluated in MSHF groups,GTP groups and SAIF groups,respectively.Results1.In MSHF groups,8 patients were able to take food,blocked the tube and had no pharyngeal fistula in8 days to 14 days after operation.They received radiation therapy for 60Gy in 5 to 22 months after operation.The vocal and swallowing functions have recovered in all 8 patients.2.In GTP groups,the swallowing functions have recovered in all 7 patients.Laryngeal function was reserved in 5 patients,loss voice in 2 patients,complications:there was bleeding and chylous leakage in 1 patient,psychiatric abnormalities in 1 patient,subcutaneous emphysema of chest wall in 1 patient.3.In SAIF groups,the size of the flaps was measured in(5-8)cm×(7-10)cm.All six flaps survived,and there were no donor-site complications except minor dehiscence in 1 patient.The swallowing functions have recovered in all 6 patients,loss voice in1 patient.Conclusion1.MSHF,GTP and SAIF all can be used to reconstruct for head and neck oncologic defects.2.CTA is useful for locating supraclavicular artery.3.The pedieled SAIF provides an alternative to free-tissue transfer for soft-tissue reconstruction after laryngeal cancer and hypopharyngeal carcinoma surgery.This flap is easy to harvest and versatile,which is especially suitable for reconstruct head and neck defects of laryngeal cancer and hypopharyngeal carcinoma in late-stage patients. |
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