Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Reconstruction of total laryngectomy defect with vascularized tissue helps to promote healing and minimize the risk of pharyngocutaneous fistula development for patients undergoing salvage surgery or those with locally very advanced disease. Common free flaps utilized in this setting are radial and anterolateral thigh free. In this case series, we review a single institution experience with using parascapular free flap. Our review identified 28 patients who underwent either primary or salvage laryngectomy with parascapular free flap reconstruction between 2020 and 2024. All reconstruction was performed by the senior author.
The average age of the patients in the sample was 66.5 years old (± 8.2) and 82% were males with an average body mass index of 23.9 kg/m2 (± 4.4). Of the 28 patients, 13 (46%) underwent salvage surgery, 4 (15%) had also total pharyngotomy, and 8 (29%) had also some degree of base of tongue resection. All but one of the patients were reconstructed with a cutaneous patch with an average surface area of 30.4 (± 14.1) cm2. One patient had a tubed flap. The most common recipient vessels for microvascular anastomosis were the facial artery and vein. Average operative time was 6.6 (±1.2) hours. There were no surgical complications related to microvascular anastomosis. Donor site morbidity was low, as only one patient experienced delayed wound dehiscence which was managed conservatively with wound packing. Six patients developed pharyngocutaneous fistula, only one of whom required surgical intervention. The length of hospital-stay ranged from 5 to 22 days and the length of not eating anything by mouth range was 7 – 56 days in the postoperative period.
Our experience demonstrates that the parascapular free flap is a viable option for reconstruction of defects secondary to both primary and salvage laryngectomy. It has comparable outcomes to previously reported reconstruction methods. There is minimal donor site morbidity, and free flap harvest does not lead to longer operative time.