Tube-in-a-Tube Anterolateral Thigh Flap for Reconstruction of a Complex Esophageal and Anterior Neck Defect

Abstract

Restoration of a functional digestive track along with acceptable external neck coverage traditionally requires 2 separate flaps. We present a case of a 65-year-old man with a large cervical and esophageal defect treated successfully with a single anterolateral thigh (ALT) free flap. This patient had been treated with primary chemoradiation for laryngeal cancer, and subsequently, developed a severe esophageal stricture. He had undergone prior multiple attempts at reconstruction with a pectoralis major, radial forearm, and deltopectoral flaps, skin grafts, and gastric pull-up, which had all failed. We used an ALT free flap that was designed in a "tube-in-a-tube" fashion to simultaneously reconstruct the cervical esophagus while resurfacing the anterior neck. The patient successfully restarted a liquid diet on the 19th postoperative day. Tube-in-a-tube ALT flap design is a reliable and efficient way to concurrently restore esophageal continuity and provide anterior neck coverage in a single-stage procedure.

Esophageal reconstruction after oncological total laryngopharyngoesophagectomy: Algorithmic approach

“…The “butterfly” is also safe because the leakage is easy to detect, the fistula is exteriorized to the surface of the flap, and the leakage does not accumulate in the neck. Only Komorowska‐Timek and Lee mention using a free anterolateral thigh flap as a salvage procedure for a failed GP. We first used a free anterolateral thigh flap combined with GP in the primary reconstruction of a total laryngopharyngoesophagectomy.…”

Reconstructive Trends in Post-Ablation Patients with Esophagus and Hypopharynx Defect

“…In a complex soft tissue defect, the reconstruction of both the esophagus and anterior neck skin requires multiple flaps. A free flap had been designed in a ''tube-in-a-tube'' fashion or in a Chimeric pattern for simultaneous reconstruction of the complex cervical esophagus [ 36 ]. With RFFF for reconstruction of the esophagus, cervical anastomotic leakage was prevented with on-lay vascularized muscle flaps [ 37 ].…”

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

“…Refinements in hypopharyngeal reconstruction techniques target early flap loss, fistula, and stricture . Murray et al reviewed recent innovations, but did not identify any modification that independently reduced complications.…”

“…Innovations in pharyngoesophageal reconstruction address flap loss, fistula and stricture, but long‐term outcomes data are scarce in the literature. Strictures and fistulae, the yardstick outcomes of most studies, are a costly nuisance but may improve with nonoperative management.…”