Refinements in flap design and inset for pharyngoesophageal reconstruction with free thigh flaps

Abstract

A refined thigh flap design and inset method in pharyngoesophageal reconstruction may circumvent complications arising from toxic drainage and vascular injury. However, there are insufficient data to make meaningful comparisons to alternative methods. © 2015 Wiley Periodicals, Inc. Microsurgery 37:112-118, 2017.

Fasciocutaneous free flaps for reconstruction of hypopharyngeal defects

“…However, it is important to not underestimate the impact of this aspect on outcomes and complications. In this view, the majority of authors do not detail their surgical technique or describe the employment of fasciocutaneous flaps in a tubular fashion when reconstructing CH defects, with highly variable outcomes, going up to 53% for PCF and 36% for PES . In our experience, suturing in a horseshoe shape the lateral edges of the free flap to the prevertebral fascia for CH leads to a large neopharynx, with low PES rates and reduced amount of tissue needed for reconstruction, thus favoring the wound closure at the level of the donor site.…”

“…In this view, the majority of authors do not detail their surgical technique or describe the employment of fasciocutaneous flaps in a tubular fashion when reconstructing CH defects, with highly variable outcomes, going up to 53% for PCF and 36% for PES. 9,47,48 In our experience, suturing in a horseshoe shape the lateral edges of the free flap to the prevertebral fascia for CH leads to a large neopharynx, with low PES rates and reduced amount of tissue needed for reconstruction, thus favoring the wound closure at the level of the donor site. In fact, the amount of transferred tissue was maximum 14 cm in length and 8 cm in width, allowing direct suture at the ALT donor site and minimizing the size of skin graft in the RF (usually applied for smaller defects).…”

The free inverted omega‐shaped flap for circumferential hypopharyngeal reconstruction with simultaneous neck skin defect

“…All these can exacerbate stenosis. Recently Zelken et al described the delta‐inset thigh flap (dITF): it has been designed to shield irradiated, skeletonized great vessels of the neck from additional irradiation and exposure‐related vascular injury. Our omega flap, brining extra soft tissue in the neck area, has a protection function of the neck vessels as well.…”

Reconstruction of Pharyngeal Defects

“…The muscle can serve to provide coverage of the great vessels in the case of concurrent radical neck dissections, to fill in neck contour defects, or as a vascularised bed to facilitate skin grafting for the external neck. A distal or a second skin paddle can be brought out to external skin and utilised as a monitoring paddle [45].…”