Safe Supraclavicular Artery Island Flap (SCAIF) Harvest using the SPY-Elite Intra operative Perfusion Assessment System (SPY)

Objectives: Indocyanine green angiography is a useful intraoperative tool to assess flap survivability that has been successfully applied in many areas of reconstructive surgery. Herein, we describe the first application of indocyanine green angiography in assessing the viability of a supraclavicular artery island flap (SCAIF) with the goal of demonstrating its usefulness in preventing major post-operative complications. Methods: We present a case report of a patient who had previously undergone multiple neck surgeries and neck irradiation that subsequently developed a laryngo cutaneous fistula amenable to closure with a SCAIF. The SPY-Elite Intraoperative Perfusion Assessment System (SPY) was used to assess intra-operative flap viability. Results: The distal flap end was shortened at two separate occasions during the case when a SPY perfusion assessment demonstrated poor distal flow. Post-operatively, the flap healed with 100% take, and the patient did not experience any complications from the surgery. Conclusion: Our application of the SPY to assess the viability of a SCAIF intraoperatively prevented a major post-operative complication. Overall, indocyanine green angiography is a useful tool in head and neck reconstruction, and we believe that its use should be applied liberally to the SCAIF to prevent distal flap necrosis.