The application of free anterolateral thigh flap with a reporter skin paddle in the reconstruction of circumferential hypopharyngeal defects

Abstract

To study the short-term results and technological improvement of free anterolateral thigh (ALT) flaps in the reconstruction of circumferential hypopharyngeal defects. The free ALT flap with a reporter skin paddle was used in 22 cases with circumferential hypopharyngeal defects. The short-term results of reconstructive surgeries and key points, advantages and complications of this technique were summarized. The length of circumferential hypopharyngeal defects ranged from 7 to 9 cm. ALT flap with an area of (8-9) cm × (11-18) cm was harvested. A reporter skin island with the skin area of (2.0-3.0) cm × (2.5-4.0) cm was designed. 91% (20/22) of ALT flaps survived. Two cases with flap necrosis underwent second reconstruction with a pedicled pectoralis major flap. All the patients had patent anastomotic lumen. Good postoperative subjective swallowing evaluation was obtained in 59% (13/22) of patients; 41% (9/22) of patients had acceptable swallowing results. Three patients (14%) presented with postoperative pharyngocutaneous fistula. One case recovered spontaneously in short-term and other two cases received the second reconstructive surgery. The application of free ALT flap with a reporter skin paddle in the reconstruction of circumferential hypopharyngeal defect is technologically easy and reliable, with satisfying swallowing function and limited trauma.