Facial reconstruction with extended supraclavicular flap after necrotizing fasciitis: Case report

Este relato de caso descreve um caso clínico de fasceíte necrotizante de face submetida a tratamento cirúrgico para reconstrução facial utilizando retalho supraclavicular estendido. Uma das abordagens para reconstrução facial é a utilização de retalho expandido, autonomizado. Realizou-se o controle infeccioso da lesão com antibioticoterapia ampla e desbridamentos cirúrgicos de todo tecido necrótico, procede-se a cirurgia reparadora, primeiramente com preparo do retalho e posterior transferência de pele supraclavicular estendida para o local afetado. Este relato evidencia um caso raro e enfatiza a importância do diagnóstico precoce, da abordagem cirúrgica realizada com brevidade e do sucesso com reparação utilizando o retalho supraclavicular autonomizado. O retalho supraclavicular expandido é uma excelente opção para reconstrução da face em pacientes em que foram removidas extensas áreas de pele, pois apresentaram boa vascularização e aspecto estético adequado no pós-operatório. Palavras-chave: Retalhos autonomizados, reconstrução facial, retalho supraclavicular, cirurgia reconstrutiva, retalho cirúrgico.

Use of Supraclavicular Flap by End to Side Technique in Pharyngeal SCC: A Case Report and Review of Literature

Objectives. In recent years, conservation laryngeal surgeries, including partial pharyngectomy, have been introduced as an alternative procedure for selected cases of hypopharyngeal squamous cell carcinoma (HSCC). Reconstruction of these defects presents a considerable challenge for the surgeon after partial pharyngectomy due to its circumferential nature. In this case report, we represent the innovative “End to side” technique to reconstruct hypopharyngeal defect using the rolled supraclavicular flap after laryngeal-preserving partial pharyngectomy. Methods and Results. A 70-year-old female presented with a history of progressive dysphagia and odynophagia. The evaluations revealed a T3N0M0 SCC of pyriform sinus. The mass was successfully resected through partial pharyngectomy, and the hypopharyngeal defect reconstruction was achieved using the rolled supraclavicular flap via the “End to side” technique. The patient was discharged after decannulation on day 10. The 3-week barium swallow was performed with no evidence of anastomotic leakage, and the oral feeding was started after NG tube removal. At week 5, complete movement of the true vocal cord on the one side and good phonation and deglutition was observed. There was no evidence of recurrence after 1 year. Conclusions. Laryngeal-preserving partial pharyngectomy and hypopharyngeal reconstruction with the rolled supraclavicular flap via the “End to side” technique could lead to good oncological and functional outcomes in selected cases of pyriform sinus.

Supraclavicular Flap for Large Anterior Chest Wall Defects–A Road Less Travelled

Large upper central chest wall defects are a reconstructive challenge. The commonly described flaps for this area do not provide very large skin paddle, and free tissue transfer remains the only option for large skin defects. Supraclavicular flap as a local flap is widely used for head and neck reconstruction and has been described for upper chest wall defects earlier. We have used nonislanded supraclavicular flap for reconstruction of two cases of large chest wall defects, which would otherwise need free tissue transfer, single flap in one case and bilateral flaps in the other. It is easy to do and has minimal morbidity. Supraclavicular flap offers a simple solution for large skin defects of the upper central chest wall and is especially useful in patients with high-operative risk and guarded prognosis.

Closure of tracheocutaneous fistula using prefabricated conchal bowl cartilage and a supraclavicular flap

BackgroundTracheocutaneous fistula represents one of the most troublesome complications of prolonged tracheostomy. Simple closure of a fistula can be ineffective, particularly in the context of prior surgery and adjuvant radiation. As such, modes of repair have expanded to include locoregional flaps and even free tissue transfers.ObjectiveThis paper describes a case of persistent tracheocutaneous fistula in an irradiated patient who had undergone previous unsuccessful attempts at repair.Method and resultsThe use of regional fasciocutaneous supraclavicular flap with prefabricated conchal bowl cartilage resulted in successful closure of the tracheocutaneous fistula.ConclusionThis represents a novel technique for closure of such fistulas in patients for whom previous attempts have failed. This mode of repair should be added to the surgeon's repertoire of reparative techniques.