Reconstruction of the hypopharynx with the anterolateral thigh flap: Defect classification, method, tips, and outcomes

Background: The authors retrospectively reviewed their experience over the past 5 years with reconstructions of hypopharyngeal defects using anterolateral thigh flaps. The purpose of the study was to present a modified classification of defects, the method and tips used, and outcomes and morbidities. Methods: From 2002 to 2007, 55 anterolateral thigh flaps were harvested for reconstruction of hypopharyngeal defects after tumor ablation in 54 patients. Patient age ranged from 38 to 77 years (average, 54 years). In 24 cases, free flaps were used for reconstruction of circumferential defects; in 28 cases, they were used to reconstruct partial defects; and in three cases, they were used to reconstruct circumferential and skin defects. Results: Total flap loss occurred in one patient and partial flap loss occurred in three patients. Strictures occurred in three patients and fistulas occurred in 10. In one case, arterial occlusion was noticed postoperatively. The arterial anastomosis was revised and the flap was salvaged. In another case, venous occlusion was noticed. The vein was reanastomosed with a vein graft and the flap was salvaged. Postoperatively, seven patients tolerated a regular diet. The donor site was skin grafted in five cases, closed with reverse anterolateral thigh in one case and with retrograde V-Y advancement flap in one case, and closed primarily in the rest. There were no donor-site complications. Conclusion: Reconstruction of the hypopharynx with the anterolateral thigh flap offers versatility in the coverage of large and complex defects and is associated with minimal donor-site morbidity.