Modified design of anterolateral thigh flap for total pharyngolaryngectomy reconstruction: A single-center experience

Li Yen Cheng, Cha Chun Chen, Hwang Chi Lin, Chu Hsu Jeng, Shang Hsi Lin, Wei Nung Jim Chen, Yu Hsien Lin*, Sheng Po Hao

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

2 Scopus citations

Abstract

Background Defects after total pharyngolaryngectomy for hypopharyngeal cancer often require reconstruction via free tissue transfer. Recently, anterolateral thigh (ALT) flap has become the gold standard in many centers because of its advantages with respect to versatility, minimal donor-site morbidity, good speech quality, and relatively low fistula and anastomotic leakage rates. Moreover, ALT allows 2 surgical teams to work simultaneously. However, the height of the parallelogram in the ALT design for neoesophagus reconstruction is usually set at a minimum of 9.4 cm (circumference, 2πr) for smooth food passage. Because this height exceeds 8 cm, the donor site may not be closed primarily, which highly depends on the patient's body habitus and the skin tone or quality and requires other methods, such as local flap or skin graft for wound closure, which subsequently increase operating time and donor-site complication rate. Objectives Thus, we aimed to construct a simple and modified ALT design that will not only include the advantages described earlier but also provide adequate donor-site primary closure without jeopardizing complication rates. Methods Ten patients with hypopharyngeal cancer underwent reconstructive surgery using our modified ALT design after total pharyngolaryngectomy between 2010 and 2017. Our modified ALT design converts this "classical" shape into a parallelogram so that the height of the modified design is always less than 8 cm, thus allowing for easy primary closure of the wound. Results The donor-site defects of all 10 patients were closed primarily. No donor-site complications and partial or total flap loss were observed. One patient experienced persistent wound infection with dehiscence, for which debridement was performed. The stricture and fistula rates were 10% (n = 1) and 20% (n = 2), respectively. The mean follow-up time is approximately 1 year. Conclusions Minimizing donor-site morbidity is an important goal in reconstructive surgery. Our modified ALT flap design is simple, enabling easy primary closure of the donor-site defect, with improved results for the patient and operators. Furthermore, this design is also suitable for ALT flaps with widths larger than 8 cm.

Original languageEnglish
Pages (from-to)62-67
Number of pages6
JournalAnnals of Plastic Surgery
Volume81
Issue number1
DOIs
StatePublished - 01 07 2018
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc.

Keywords

  • ALT
  • anterolateral thigh flap
  • head and neck reconstruction
  • modified flap design
  • pharyngolaryngectomy reconstruction

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