Free tissue transfer has become the mainstay of complex head and neck reconstruction. Nonetheless, certain preoperative considerations, including prior neck dissection, radiotherapy, and severe medical comorbidity, can substantially increase patients’ risk of free flap failure.1 Several other factors, including duration of anesthesia, coagulopathy, diabetes, and substance abuse have been associated with major postoperative complications after head and neck reconstruction.2 Regional tissue options, such as the supraclavicular artery island flap (SCAIF), can be reliably harvested in patients with multiple risk factors, limiting medical and flap-related complications. However, subclavian devices, including pacemakers and ports, are occasionally present in those requiring salvage surgery. Although use of the SCAIF may decrease complications in patients considered high risk, the feasibility of harvest and reconstructive outcomes in the setting of preexisting subclavian devices has not been described.
Zenga J, Chen J, Deschler DG. Supraclavicular Artery Island Flap in Patients With Ports or Pacemakers. JAMA Facial Plast Surg. Published online January 04, 2018. doi:10.1001/jamafacial.2017.2150