Systematic Review of Supraclavicular Artery Island Flap vs Free Flap in Head and Neck Reconstruction

• Published in: Otolaryngology-head and neck surgery 2019-02, Vol.160 (2), p.215-222
• Main Authors: Sukato, Daniel C., Timashpolsky, Alisa, Ferzli, George, Rosenfeld, Richard M., Gordin, Eli A.
• Format: Article
• Language: English
• Subjects: free flap; free tissue transfer; head and neck reconstruction; meta‐analysis; regional pedicled flap; supraclavicular artery island flap; systematic review
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/0194599818803603

Objective The aim of this systematic review is to compare the surgical outcomes of supraclavicular artery island flap (SCAIF) and free tissue transfer (FTT) in head and neck reconstruction. Data Sources PubMed, Web of Science, and EMBASE databases. Review Methods Independent screening and data extraction were performed by 2 authors. Only studies that directly compared SCAIF and FTT were included. Data were pooled with random-effects meta-analysis to determine the standardized mean differences (SMDs), risk differences, and 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistics. The Methodological Index for Non-Randomized Studies tool was used to evaluate extent of bias in studies. Results The initial query yielded 661 results, of which 4 comparative studies remained for final analysis. The pooled sample sizes for the SCAIF and FTT cohorts were 100 and 84, respectively. SCAIF was associated with reduction of operative time by a large effect size (SMD, 1.65; 95% confidence interval, 0.78-2.52). The harvested flap areas and perioperative complications, including rates of total flap loss, partial flap necrosis, and recipient/donor site dehiscences, were comparable between the 2 procedures with low to high heterogeneity among studies. Conclusion SCAIF requires less operative time and has comparable short-term perioperative results to FTT. The findings of this study support the viability of SCAIF as an alternative to FTT and provide evidence for its inclusion in the reconstructive armamentarium of major head and neck ablation and trauma.