The anterolateral thigh perforator flap in pharyngo-esophageal reconstruction

Frémicourt, Minh Kim de; Temam, Stéphane; Janot, F.; Kolb, F.; Qassemyar, Q.

doi:10.1016/j.anplas.2017.09.004

Cited by 6 publications

(6 citation statements)

References 21 publications

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“…It can be used in the reconstruction of vessel-depleted neck and in difficult necks [9]. In our series, SCAIF was successfully used in ten patients, with previous (chemo)radiotherapy and multiple treated necks, as an excellent alternative to microsurgical free flaps [22,23].…”

Section: Discussionmentioning

confidence: 97%

Head and neck reconstruction: The supraclavicular flap: technical note

Javadian

Bouland

Rodriguez

et al. 2019

Annales de Chirurgie Plastique Esthétique

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Section: Discussionmentioning

confidence: 97%

Head and neck reconstruction: The supraclavicular flap: technical note

Javadian

Bouland

Rodriguez

et al. 2019

Annales de Chirurgie Plastique Esthétique

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“…Secondary cases of cervical esophageal reconstruction can be challenging due to the extensive damage to soft tissues producing large defect size after debridement and to the poor conditions of recipient vessels due to previous surgery and radiotherapy [9]. In this context, locoregional flaps are usually insufficient, while intestinal flaps bring a high risk of complications to a patient already burdened by a compromised status [10]. Therefore, these patients require a thoughtful approach, preferring safe techniques and employing an extensive preoperative examination.…”

Section: Discussionmentioning

confidence: 99%

Secondary Microsurgical Reconstruction of the Cervical Esophagus: Safer Flaps and Practical Tips in a Challenging Situation

Ramella,

Ferrari,

Novati

et al. 2024

Preprint

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Background. Cervical esophageal reconstruction is vital for improving the quality of life in cancer surgery patients. Microsurgery is crucial, providing vascularized tissue for defect repair, particularly in secondary cases with a higher risk of failure due to larger defects and damage from previous surgery and radiotherapy. The purpose of this study was to describe the clinical characteristics of a series of patients who underwent secondary repair of esophageal defects and provide practical information for the management and treatment of such cases based on the authors' experience and the literature review. Methods. We retrospectively reviewed the electronic medical records of the Plastic Surgery Clinic at the University of Trieste to identify cases of patients who underwent secondary esophageal microsurgical reconstructions following oncological surgery. Patient demographics, etiology of esophageal defects, previous surgical history, and preoperative assessments were collected from medical records. Surgical techniques employed for reconstruction, such as pedicled flaps or free tissue transfers, were documented along with intraoperative details. Postoperative outcomes, including complications, graft viability, and functional outcomes, were evaluated during follow-up. Results. We treated 13 cases of secondary esophageal reconstructions from 2011 to 2022. Most commonly, Antero-Lateral Thigh (ALT) flaps were used in 10 cases, while 2 cases employed Radial Forearm Flap (RFF), and 1 a chimeric parascapular flap. No flap failures occurred during a median 50-month follow-up. One ALT flap patient experienced post-op stricture but maintained swallowing ability. A single tracheoesophageal fistula occurred in a RFF patient with a history of radiotherapy and completion lymph node dissection. Conclusions. Cervical esophageal reconstruction significantly impacts patients' quality of life by restoring oral feeding and phonation. When local flaps fall short, microsurgical reconstruction with intestinal flaps is valuable, but burdened by limitations. For challenging secondary cases, ALT or RFF flaps emerge as safer options due to their robust pedicles, yielding low complication rates and positive functional outcomes.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…If the flap volume was insufficient to fill up the space and heal with surrounding tissue, resulting in an “empty neck,” a higher risk of leakage and late fistula formation could be expected (Figure 1 ). 17 , 25 This idea could be applied to the use of an RF flap. Many studies have found a higher risk of fistula formation in the RF flap reconstruction population, 11 , 19 , 26 which could be the reason.…”

Section: Discussionmentioning

confidence: 99%

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

Hsieh

Chen

Lin

et al. 2023

Laryngoscope Investig Oto

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Background We usually use an ALT or peroneal flap in total laryngectomy reconstruction, depending on the surgeons' preference. No direct comparison of the outcomes of the ALT flap and peroneal flap exists. Methods From 2014 to 2022, we reviewed patients who had total laryngectomy and were reconstructed with an ALT flap and peroneal flap. Patient characteristics and surgical outcomes were collected and compared. Results The peroneal group had a significantly higher risk of neopharynx leakage (40% vs. 13.2%, p = .020) and late pharyngocutaneous fistula formation (30% vs. 5.3%, p = .009) than the ALT group. Peroneal flap was found to be the only independent risk factor for neopharynx leakage (p = .025, odds ratio [OR] = 5.5) and late pharyngocutaneous fistula formation (p = .02, OR = 7.7) in multivariate logistic regression. Conclusion In the reconstruction of total laryngectomy, the ALT flap is preferable over the peroneal flap.

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The anterolateral thigh perforator flap in pharyngo-esophageal reconstruction

Cited by 6 publications

References 21 publications

Head and neck reconstruction: The supraclavicular flap: technical note

Head and neck reconstruction: The supraclavicular flap: technical note

Secondary Microsurgical Reconstruction of the Cervical Esophagus: Safer Flaps and Practical Tips in a Challenging Situation

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

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