Oropharyngeal reconstruction is a challenging procedure. Regional flaps, such as pectoralis major, trapezius, deltopectoral, or their modifications,3 may result in significant functional morbidity. Microsurgical reconstruction may be severely hampered in cases of irradiated or infected surgical fields, such as in our patient, or contraindicated in patients with poor clinical conditions. In this context, the supraclavicular artery island flap is a reliable option, being pedicled and harvested easily, quickly, and with minimal donor-site morbidity.1,4 Permacol is an acellular porcine dermis composed of type I and type III collagen and a small amount of elastin. Its biocompatibility has been shown, with the integration of host cells and neovascularization in the collagen matrix of the implant; moreover, it can be used in contaminated surgical fields.5 As pointed out by Anand and colleagues, the main drawback of the supraclavicular artery island flap is the postoperative fistula rate, which is further increased by radiation therapy. In our patient, who had been irradiated and was locally infected, the supraclavicular artery island flap allowed local coverage and neck mobility, and mucosal lining with the acellular dermal matrix promoted regeneration of orthotopic tissue. This tissue, combined with preventive treatment of parotid glands by botulinum toxin injection, provided a higher resistance to saliva and digestive enzymes than the cutis of a flap, thus allowing the closure of the 3 × 3-cm fistula. In our experience, the combination of supraclavicular artery island flap with Permacol allowed the achievement of a solid reconstruction with no fistula relapse.
Paolo Persichetti, M.D., Ph.D.
Achille Aveta, M.D.
Francesco Segreto, M.D.
Plastic, Reconstructive, and Aesthetic Surgery Unit, Campus Bio-Medico of Rome University, Rome, Italy
The authors have no commercial associations that might pose or create a conflict of interest with information presented in this communication. No funding was received.
1. Anand AG, Tran EJ, Hasney CP, Friedlander PL, Chiu ES. Oropharyngeal reconstruction using the supraclavicular artery island flap: A new flap alternative. Plast Reconstr Surg. 2012;129:438–441.
2. Pallua N, Demir E. Postburn head and neck reconstruction in children with the fasciocutaneous supraclavicular artery island flap. Ann Plast Surg. 2008;60:276–282.
3. Persichetti P, Francesco Marangi G, Gigliofiorito P, Segreto F, Brunetti B. Myocapsular pectoralis major flap for pharyngeal reconstruction after cervical necrotizing fasciitis. Plast Reconstr Surg. 2010;126:2279–2281.
4. Liu PH, Chiu ES. Supraclavicular artery flap: A new option for pharyngeal reconstruction. Ann Plast Surg. 2009;62:497–501.
5. Balayssac D, Poinas AC, Pereira B, Pezet D. Use of Permacol in parietal and general surgery: A bibliographic review. Surg Innov. E-published ahead of print June 13, 2012.
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