Interdisciplinary defect reconstruction of upper aerodigestive fistulas-case series and treatment algorithm

Abstract

Persistent complex defects and dysfunctions of the upper aerodigestive tract after tumor surgery represent amajor challenge. The aim of this study was to evaluate the effectiveness of an interdisciplinary approach using the free anterolateral thigh flap (ALT) as areconstruction option in the upper aerodigestive tract. The retrospective study identified 5patients with complex defects after laryngectomy/pharyngolaryngectomy (LE/PLE) and multiple revision surgeries between 2017 and 2023. The operations were performed by an interdisciplinary team from otolaryngology, plastic surgery, and visceral/thoracic surgery. The results of the microsurgical reconstruction were analyzed. There was an average of six previous operations. The defects included tracheoesophageal fistulas, pharyngocutaneous fistulas, neopharyngeal stenosis, and combinations thereof. Successful reconstruction was achieved in 100% of patients using the ALT flap. In 2patients, ALT flow-through flaps were used with an additional free jejunal interposition (JI) and in 3patients split-ALT flaps were used. The major complication rate was 40% and the minor complication rate was 20%. Complex defects of the upper aerodigestive tract with multiple previous operations can be successfully reconstructed. Because of its versatility, the ALT flap seems to be avery good option. Prerequisite for this is an interdisciplinary treatment approach with acritical assessment of patient- and disease-specific factors.