Clinical application of thoracoacromial artery perforator flap for hypopharyngeal reconstruction

Abstract

To explore the clinical effect of thoracoacromial artery perforator (TAAP) flap as a reconstructive option for hypopharyngeal defects. Between June 2011 and November 2015,TAAP flap was used to restore oncologic hypopharyngeal defects in 13 patients with recurrence of hypopharyngeal carcinoma. The size of hypopharyngeal defects ranged from 7.0 cm× 4.5 cm to 8.5 cm × 5.5 cm. Doppler was used to detect the location of thoracoacromial artery perforator. The flap was designed on the line joining the acromion to the xiphoid process with the size 0.5-1.0 cm larger than the defect,the flap was passed under the clavicular head of the pectoralis major and under the clavicle bone and sternocleidomastoid to the recipient site for insetting. The donor site was closed directly. The size of TAAP flap is from 7.0 cm×5.0 cm to 9.5 cmu×6.0 cm. The length of pedicle is 7.5-9.0 cm. The distance from pivot point of flap to central point of recipient site was 9.0-10.5 cm. All 13 flaps survived completely, the defect at donor site was closed directly in all cases. Good appearance was achieved at 8 months to 42 months' follow up, with no recurrence, fistulas, stenosis/strictures, dehiscence, or swelling, only linear scars were left on the donor sites, pectoralis major muscle function was completely preserved in all patients. TAAP flap is a good choice for reconstruction of hypopharyngeal defects.