Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
BACKGROUND: Anterolateral thigh (ALT) free flap has recently become a decent option for reconstruction total laryngopharyngectomy defects and remains a surgical challenge if it is based on single paddle designed tube flap with suprastomal cutaneous monitoring paddle. The purpose of this study was to analyse the clinical and functional outcomes achieved using this technique.
METHODS: Single paddle ALT flap with intervening de-epithelialised segment between the portion of the flap, was used to reconstruct the neo pharyngeal conduit and a small portion was utilised in anterior neck resurfacing for monitoring purpose in every patient. Each flap was raised on two or three perforators of the descending branch of the lateral circumflex femoral artery (dbLCFA). Direct clinical monitoring of tissue perfusion was done in the post-operative period. 15 patients were retrospectively reviewed between 2016 and 2021 and the outcomes were measured in the form of ability to swallow solid foods, flap failure, stricture formation and pharyngocutaneous leak.
RESULTS: All patients were able to swallow solid foods at mean follow up of 6 months except 2 cases had stricture formation 3 months after the completion of radiation therapy and were managed with sequential dilatations. One had small pharyngocutaneous leak at the end of 2 weeks of surgery and was treated conservatively with our own designed laryngeal strap. There were no partial or total flap losses.
CONCLUSIONS: Single paddle ALT free flap provides a reliable neo pharyngeal reconstruction, and also allows for flap monitoring and neck resurfacing utilising same skin paddle when required, with a low rate of clinically significant leaks, stricture formation or flap failure.