1. Pharyngeal reconstruction with a modified free alt flap with parastomal fascial wings.
- Author
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El-Khayat B, Anderson I, Ahmed OA, Ragbir M, Saleh DB, and Bashir MA
- Subjects
- Female, Humans, Laryngectomy methods, Male, Middle Aged, Perforator Flap, Pharyngectomy methods, Recovery of Function, Retrospective Studies, Carcinoma, Squamous Cell pathology, Carcinoma, Squamous Cell surgery, Free Tissue Flaps, Laryngeal Neoplasms pathology, Laryngeal Neoplasms surgery, Laryngectomy adverse effects, Pharyngeal Neoplasms pathology, Pharyngeal Neoplasms surgery, Pharyngectomy adverse effects, Postoperative Complications therapy, Plastic Surgery Procedures adverse effects, Plastic Surgery Procedures methods
- Abstract
Aim: Previous reports have demonstrated good outcomes with the use of the Anterolateral Thigh Flap (ALT) in pharyngeal reconstruction. We report a new modification of free ALT flap pharyngeal reconstruction utilizing vascularised fascial wings or extensions placed in the parastomal gutters to cover the major neck vessels., Patients and Methods: This was a single-center retrospective case review. Between November 2017 and January 2019, 8 patients (6 male, 2 female mean age 61, range 35 to 74) underwent near circumferential pharyngeal reconstruction by the modified technique. 3 patients had laryngopharyngectomy for radiorecurrent larynx SCC, 2 for primary, advanced laryngeal SCC, and 3 for primary hypopharyngeal SCC., Results: All eight patients regained adequate swallow to maintain nutrition without tube-feeding. Two of the patients have been assessed as appropriate for tracheo-esophageal puncture and are awaiting placement. One patient uses an electrolarynx for speech and 5 patients aphonic only. One patient died 2 months after the procedure from chest infection. There were no flap failures, no fistulas and no strictures at one year. One patient who underwent a salvage laryngopharyngectomy experienced parastomal wound dehiscence, but critically there was no return to theater for exposed major vessels and the wound healed within 6 weeks requiring dressings only., Conclusion: Here we report outcomes of pharyngeal reconstruction with a modified single perforator free ALT flap using fascial extensions to line the parastomal gutters. In the event of parastomal dehiscence, the placement of vascularized tissue parastomally may facilitate spontaneous healing and prevent major vessel exposure., Competing Interests: Declaration of Competing Interest None declared, (Copyright © 2020 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2021
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