Fasciocutaneous Free Flaps for Hypopharyngeal Reconstruction

Abstract

Considerable controversy persists regarding the optimal technique for hypopharyngeal reconstruction. The ideal procedure should provide low mortality and morbidity, short hospitalization, a high success rate, few complications, and the greatest potential for neopharyngeal speech and deglutition. In this study, a variety of fasciocutaneous free flaps were used for reconstruction of the hypopharynx. Over a two-year period, fasciocutaneous flaps were used for reconstruction of pharyngoesophageal segments following total laryngopharyngectomies in 16 patients at The National Cancer Institute, Cairo University, Cairo, Egypt. Flap survival, recipient vessels used, and complications were examined. The ultimate functional and cosmetic outcomes of free flaps were compared. Of the 16 patients included in this study, nine were males, and seven were females. Free flaps used for reconstruction included the radial forearm (8), lateral arm (2), anterolateral thigh (3), and posterolateral thigh (3) flaps. Free flaps were successful in 15 patients. One patient had total flap loss. Salvage surgery was successful for one flap that developed venous congestion. Eleven patients received adjuvant radiation therapy. The commonly used recipient vessels were the small arteries of the neck and the external jugular vein. Five patients developed minor pharyngocutaneous fistulas that healed spontaneously. Six patients developed anastomotic line stricture. Donor-site morbidity was more significant with the radial forearm flap, compared to other flaps. Fasciocutaneous free flaps have a definite place in pharyngoesophageal reconstruction. The flap should be selected with reference to the type of the defect and patient obesity; however, donor-site morbidity should also be considered.

Functional outcomes and donor site morbidity following circumferential pharyngoesophageal reconstruction using an anterolateral thigh flap and salivary bypass tube

“…16 Its main advantage over other fasciocutaneous flaps and in particular its more commonly used ''small brother,'' the radial forearm, 2 is that the donor site morbidity is more acceptable. 17,18 Primary closure of the relatively obscure donor area is preferable to the skin grafted and often unsightly appearance of the forearm donor site. The perceived problems with the ALT are the relative thickness of the flap for which a number of flap thinning techniques have been described, 19 and the dissection of the perforator.…”

“…This causes delayed healing, temporary loss of function, 48 and an unsightly, visible scar. We, like Amin et al, 17 believe that the choice of fasciocutaneous flap reconstruction must consider the donor site morbidity prior to deciding the reconstructive procedure.…”

Reconstructive potential of the lateral arm flap after tumor resection

“…Segmental defects of these tubular structures can be rebuilt with fasciocutaneous lateral arm flaps, achieving good results regarding speech and deglutition. 21,28 When the flap is used in the pharynx and proximal esophagus, the mucous-cutaneous sutures must be carefully adapted to avoid fistula formation.…”

Free anteromedial thigh flap: Clinical application and review of literature

“…Defects of the head and neck region after tumor excision often require flaps with similar qualities as those for the lower limbs. 7,8 Thus, they may seem appropriate in a multitude of clinical settings where reliable coverage is needed. Additionally, muscle flaps require skin grafting, and there is a certain degree of functional donor-site morbidity.…”