A flag-shaped anterolateral thigh free flap for complete circumferential hypopharyngeal reconstruction with dead space obliteration and monitoring flap inset.

Background: The challenging issues are to prevent anastomotic leakage and provide sufficient flap monitoring in circumferential hypopharyngeal reconstruction. In this study, a newly designed flag-shaped anterolateral thigh (ALT) free flap was used for circumferential hypopharyngeal reconstruction to address these issues.
Methods: Eighteen ALT flaps were harvested for reconstruction of circumferential hypopharyngeal defects from 2013 to 2016. The harvested ALT flap was sutured into a cylinder shape, and a triangular extension of the flap was used for dead space obliteration and flap monitoring. All data regarding outcomes and complications including radiographic investigations were collected retrospectively.
Results: The flap had a rectangular shape with dimensions of 29 cm × 8 cm (range, 25-31 cm × 6-10 cm). For each flap, 2-4 perforators were included (average, 2.6 perforators/flap). All flaps survived. One venous thrombosis was diagnosed early through the monitoring portion of the flap, and the flap was salvaged after thrombectomy with a vein graft. The mean follow-up period was 28.9 months (10.3). There was one case of definitive fistula (4%), which never healed because of early tumor recurrence. Three postoperative strictures were noted (21.4%).
Conclusions: For a complete circumferential hypopharyngeal defect, the flag-shaped ALT free flap design offers monitoring flap and dead space obliteration and prevents anastomotic leakage.
(Copyright © 2019 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)