Pharyngeal Reconstruction with Microvascular Free Tissue Transfer

Abstract

Reconstruction of pharyngoesophageal defects after total laryngectomies and extirpation of hypopharyngeal and upper esophageal carcinomas presents a challenging task. Goals of reconstruction include adequate voice rehabilitation and restoration of normal swallowing. The reconstructive armamentarium contains many options for reconstruction and creation of a new upper digestive tract. This review article focuses on the most commonly used free tissue transfer options for the reconstruction of these defects, with an assessment of their advantages and disadvantages.

Comparison of the outcomes of anterolateral thigh flap and peroneal flap in total laryngectomy reconstruction

“…The ALT flap is a popular flap that has dependable perforators, a large donor site skin area, a long vascular pedicle, and a low donor site morbidity. The main concern in the use of the ALT flap in the reconstruction of total laryngectomy is its thickness and bulky volume, which are related to poor tubularization compliance and space overcrowding in extremely obese patients 9–11,16–18 . Radial forearm (RF) flaps are also commonly used in total laryngectomy reconstruction.…”

“…It is a thin and pliable flap with a long vascular pedicle and good compliance. The disadvantage of the RF flap is the relatively small donor site area and the poor cosmetic appearance of the donor site 9,10,18–21 . Many articles have been written about which flap is a better choice in the reconstruction of total laryngectomy.…”

“…The main concern in the use of the ALT flap in the reconstruction of total laryngectomy is its thickness and bulky volume, which are related to poor tubularization compliance and space overcrowding in extremely obese patients. 9 , 10 , 11 , 16 , 17 , 18 Radial forearm (RF) flaps are also commonly used in total laryngectomy reconstruction. It is a thin and pliable flap with a long vascular pedicle and good compliance.…”

“…The disadvantage of the RF flap is the relatively small donor site area and the poor cosmetic appearance of the donor site. 9 , 10 , 18 , 19 , 20 , 21 Many articles have been written about which flap is a better choice in the reconstruction of total laryngectomy. The conclusion was still debatable.…”

Efficacy and Safety of Microsurgical Pharyngolaryngeal and Pharyngoesophageal Reconstruction: A Systematic Review of the Literature

“…The advantages of the free ALT flap are minimal donor-site morbidity, versatility, quicker spontaneous healing of small fistulas and strictures, high-quality speech restoration, full initiation of oral diet, fewer postoperative complications, and shorter intensive care unit stay. 19,20 The disadvantages include the variability of its vascular anatomy and its inconsistency of subcutaneous adipose tissue. Although the flap is raised as a perforator suprafascial flap, the thickness of the subcutaneous tissue determines whether or not it can be tubed.…”