Supraclavicular pedicled flap for hemiglossectomy defect reconstruction with pull-through approach : a feasibility study

Purpose: Tongue reconstruction is challenging, to restore swallowing, speech function, airway protection and cosmetic. While free flaps are considered the standard reconstructive option of hemi-glossectomy, alternative techniques with pedicled flap could be necessary, notably for insuitable microvascular patients. However, regional flap insertion in the oropharynx is often difficult, requiring mandibular split. The objective of this study is to assess the feasibility of hemiglossectomy defect reconstruction with supraclavicular flap with a combined trans-oral transcervical approach (pull-through) resection. Methods: First, eight supraclavicular and lateral triangles of the neck regions were dissected, measuring the distance between origin of the supraclavicular artery and clavicule and sternoclavicular joint. Then, twenty surgical procedures of hemiglossectomy with pull-through approach and reconstruction with supraclavicular flap were performed on ten cadavers. Feasibility of the different surgical steps were noted with Five-points Likert scale A score below 3 was considered insufficient. Finally, this procedure was applied in three patients. Results : Supraclavicular flap is a good option for reconstruction of the tongue with pull-through approach. No flap compression, on the hyoid bone or mandible was notified. Because of thinness, the neo-tongue conformation was excellent (4,4 points). Rotation arch of 180° allowed in all cases correct positoning without tension, but required in six cases skeletonization of vascular pedicle. Suture of proximal skin paddle on tonsillar pillar and vallecula were difficult but feasible (3,4 points) and important in order to limit pharyngocutaneous fistula. Conclusion: Supraclavicular flap reconstruction offers an effective alternative for hemiglossectomy defect reconstruction with pull-through technique resection. This technique balances surgical accessibility with preservation of mandible, resulting in an acceptable level of morbidity