THE RELIABILITY OF SUPRACLAVICULAR ARTERY ISLAND FLAP (SCAIF)

IN HEAD AND NECK RECONSTRUCTION AFTER ABLATIVE SURGERY:

A CASE SERIES

Syafri TM*, Urahman T*, Sitanggang HH*, Irawati N**, Susilo DH**, Murtedjo U**, Reksoprawiro S**, Salim S**
*Trainee of Head & Neck Surgery Program Soetomo General Hospitals/ Faculty of Medicine Airlangga University
** Teaching Staff Of Head and Neck Surgery Division of Soetomo General Hospitals/ Faculty of Medicine Airlangga
University

BACKGROUND
The supraclavicular artery island flap (SCAIF) is a pedicled flap with unusual versatility, wide arc of rotation and
good color match. We present the use of supraclavicular pedicled flap in two patients with different recipient sites

CASE 1
A 52 years old male patient, farmer by occupation came to Dr. Soetomo
General Hospital with an ulcer in right ear since 6 years ago. This patient
had two times operating procedure in 2016 and 2018 in another hospital.
On examination, a single ulcer in right ears 4 cm x 2cm. This patient had
wide exicision with full thickness skin graft supraclavicular artery island flap
(SCAIF) procedure. Graft harvest was form supraclavicular ipsilateral with
the lesion site. Patient was discharged on 9th days after surgery. Post-
operative follow up on 15th day after operation showed that uptake of
graft was 100% and wound was healthy.

CASE 2
A 40 years old male patient, farmer by occupation came to Dr. Soetomo
General Hospital with an ulcer in right cheek that penetrated to buccal
mucosa since 6 months ago. On examination, the ulcer was 13 cm x 9 cm
x 7 cm. This patient had wide exicision with full thickness skin graft
supraclavicular artery island flap (SCAIF) procedure. Graft harvest was
form supraclavicular ipsilateral with the lesion site. Patient was discharged
on 7th days after surgery. Post-operative follow up on 14th day after
operation showed that uptake of graft was 100% and wound was
healthy.

DISCUSSION
Skin cancer usually develops on sun-exposed areas, especially the head
and neck region. Skin cancer was commonly seen in middle age or older
people. The SCAIF is a useful loco regional flap in head and neck
reconstruction. It is a thin, pliable flap with good color match to the head
and neck that can be rapidly elevated with primary closure of the donor
site. Since this is a rotational flap, it is also extremely useful in situation
were micro vascular free tissue transfer in not a option, and in case of
multiple prior surgeries limiting current reconstruction option. Major
complications requiring a return to the operating room are not
uncommon following SCAIF reconstruction, especially among patient
with previously irradiated necks and other comorbidities. The incidence of
distal tip necrosis is as high as 22%. Doppler is a useful tool in initial
planning of a SCAIF, but distal extension of a SCAIF that can be harvest
during surgery is not reliably predicted with Doppler alone.
Case 1 Case 2

CONCLUSION

The SCAIF is useful and versatile in head and neck reconstruction. The surgical technique is relatively easy and the
flap can be used with good cosmetic and functional outcome at both recipient and donor sites. It is an excellent
alternative for traditional regional and free flaps for head and neck reconstruction.

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