Modified Design of Anterolateral Thigh Flap for Total Pharyngolaryngectomy Reconstruction

Abstract

Minimizing donor-site morbidity is an important goal in reconstructive surgery. Our modified ALT flap design is simple, enabling easy primary closure of the donor-site defect, with improved results for the patient and operators. Furthermore, this design is also suitable for ALT flaps with widths larger than 8 cm.

Perforator‐based chimeric anterolateral thigh flap U‐shaped insetting for total pharyngoesophageal reconstruction: Surgical technique and functional outcomes

“…Amongst fasciocutaneous flaps, ALT gained increasing popularity in hypopharyngeal reconstruction because of its numerous advantages: it is anatomically consistent with a sizeable pedicle; it can be harvested as a chimeric flap including two or more skin paddles or part of the vastus lateralis muscle; it provides well‐vascularized fascia to reinforce suture lines; it enables the excisional and reconstructive team to work simultaneously reducing operative time; it has low donor site morbidity (Cheng et al, 2018). Speech production is superior compared to enteral flaps (Yu, 2012; Yu et al, 2006), furthermore, according to Murray et al (Murray et al, 2008), the swallowing function is better than the one obtained with other fasciocutaneous flaps.…”

“…Focusing on the insetting technique, the T‐junction in a tubed flap is a vulnerable point where healing is more likely to be delayed due to poor vascularization at the distal corners of the flap and subsequent wound dehiscence (Murray et al, 2008), while circumferential scarring at the proximal or distal junction can be related to stricture formation. Many modifications (Cheng et al, 2018; Ghazali et al, 2016; Murray et al, 2007; Tan et al, 2012; Zelken et al, 2017) to the conventional tubed insetting have been described over the years in the attempt to minimize complications and improve functional outcomes.…”

“…The shape of the cutaneous paddle was trapezoid with the greater base positioned cranially and the height oriented vertically, according to perforators location, to facilitate donor site primary closure. A chimeric flap was always harvested based on two perforators, with the second independent skin paddle used for both monitoring the flap and reducing tension on the neck skin closure (Cheng et al, 2018). When only one ALT perforator was found, a perforator of the transverse branch of the LCFA was dissected and nourished the second skin paddle shaping up an ALT/TFL perforator‐based chimeric flap (Hallock, 1991; Tsai et al, 2004).…”

“…Many modifications (Cheng et al, 2018;Ghazali et al, 2016;Murray et al, 2007;Tan et al, 2012;Zelken et al, 2017) to the conventional tubed insetting have been described over the years in the attempt to minimize complications and improve functional outcomes.…”

“…Pharyngoesophageal reconstruction is burdened by possible strictures and pharyngocutaneous fistulae (PCF) with subsequent potential infection and wound breakdown that might delay postoperative chemoradiotherapy and, in the worst‐case scenario, bring to failure the whole reconstructive procedure. Hence, during the last years, alternative insetting techniques (Cheng et al, 2018; Ghazali et al, 2016; Murray et al, 2007; Tan et al, 2012; Zelken et al, 2017) to the conventional tubulization have been suggested in order to minimize complications and improve functional outcomes.…”