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DOI: 10.1055/s-2006-932504
A Simplified Design of a Dual Island Fasciocutaneous Free Flap for Simultaneous Pharyngoesophageal and Anterior Neck Reconstruction
Publication History
Accepted: November 1, 2005
Publication Date:
03 February 2006 (online)
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ABSTRACT
Reconstruction of the pharyngoesophagus and pharynx can be especially challenging in patients with prior irradiation, recurrent disease, and compromised or deficient anterior neck skin. The authors report their experience with seven patients who underwent pharyngoesophageal reconstruction with a new flap design that addresses both the concerns of monitoring the internal skin tube and replacing the external neck skin with one flap. This design has two skin islands, one that is tubed and the other left flat. The authors call this design “the paddle flap” because together its two components resemble a paddle. The tubed portion resembles the “handle” of a paddle that is used for esophageal reconstruction, and the cutaneous paddle is then folded over the “handle” to provide external skin. The external skin portion of the flap not only provides an external monitoring segment but releases tension on the neck apron incision and may replace compromised native neck skin. The length of esophageal defects ranged from 4 to 11 cm and the anterior cervical skin requirements ranged from 4 × 2 cm to 10 × 12 cm. Follow-up has been between 18 months and 4 years. There were no partial or complete flap losses. All patients are currently tolerating an oral diet. There was one case of partial donor-site skin graft loss which was treated with re-grafting. There were two cases of stricture formation which were treated successfully with neo-esophageal dilatation.
This new simple, versatile design of a cutaneous free flap addresses both concerns of monitoring the internal skin tube and dealing with compromised overlying skin in patients undergoing pharyngoesophageal reconstruction. The paddle flap design can be utilized with any thin cutaneous free flap and may offer an advantage when an external monitor is desired and anterior neck skin requires supplementation or replacement.
KEYWORDS
Cutaneous free flap - paddle flap - pharyngoesophageal reconstruction - anterior neck reconstruction
REFERENCES
- 1 Shektman A, Silver C, Strauch B. A re-evaluation of hypopharyngeal reconstruction: pedicled flaps versus microvascular free flaps. Plast Reconstr Surg. 1997; 100 1691-1696
- 2 Cusumano R J, Silver C E, Brauer R J, Strauch B. Pectoralis myocutaneous flap for replacement of cervical esophagus. Head Neck. 1989; 11 450-456
- 3 Wei F C, Demirkan F, Chen H C, Chen I H, Liao C T, Hau S P. Management of secondary soft-tissue defecits following microsurgical head and neck reconstruction by means of another flap. Plast Reconstr Surg. 1999; 103 1158-1166
- 4 Disa J J, Pusic A L, Hidalgo D A, Cordeiro P G. Microvascular reconstruction of the hypopharynx: defect classification, treatment algorithm, and functional outcome based on 165 consecutive cases. Plast Reconstr Surg. 2003; 111 652-660
- 5 Gurtner G C, Evans G E. Advances in head and neck reconstruction. Plast Reconstr Surg. 2000; 106 672-682
- 6 Ariyan S. The pectoralis major myocutaneous flap. Plast Reconstr Surg. 1979; 63 73-81
- 7 Schechter G L, Baker J W, Gilbert D A. Functional evaluation of pharyngoesophageal reconstructive techniques. Arch Otolaryngol Head Neck Surg. 1987; 113 40-44
- 8 Anthony J P, Singer M I, Mathes S J. Pharyngoesophageal reconstruction using the tubed free radial forearm flap. Clin Plast Surg. 1994; 21 137-147
- 9 Byun J S, Baik B S, Park J S. An effective pharyngoesophageal reconstruction with free radial forearm flaps. Eur J Plast Surg. 1992; 15 173
- 10 Furuta S, Hataya Y, Ishigaki Y, Watanabe T. Monitoring the free radial forearm flap in pharyngo-oesophageal reconstruction. Br J Plast Surg. 1997; 50 40-42
- 11 Iwasawa M, Furuta S, Hayasi M, Ohtsuka Y, Kushima H. Use of a monitor muscle flap in buried free forearm flap transfer. Ann Plast Surg. 1996; 37 364-366
- 12 Li K K, Saliban A H, Allison G R et al.. Pharyngoesophageal reconstruction with the ulnar forearm flap. Arch Otolaryngol Head Neck Surg. 1998; 124 1146-1151
- 13 Akin S, Basurt O. A new flap design for monitoring the circulation of a buried free radial forearm flap in pharyngoesophageal reconstruction. J Reconstr Microsurg. 2002; 18 591-594
- 14 Koshima I, Yamamoto H, Moriguchi T, Orita Y. Extended anterior thigh flaps for repair of massive cervical defects involving pharyngoesophagus and skin: an introduction to the “mosaic” flap principle. Ann Plast Surg. 1994; 32 321-327
- 15 Yu P. One-stage reconstruction of complex pharyngoesophageal, tracheal, and anterior neck defects. Plast Reconstr Surg. 2005; 116 949-956
- 16 McCarthy C M, Kraus D H, Cordeiro P G. Tracheostomal and cervical esophageal reconstruction with combined deltopectoral flap and microvascular free jejunal transfer after central neck exenteration. Plast Reconstr Surg. 2005; 115 1304-1310 discussion 1311-1313
- 17 Chmura S J, Milano M T, Haraf D J. Reirradiation of recurrent head and neck cancers with curative intent. Semin Oncol. 2004; 31 816-821
- 18 Salama J K, Vokes E E, Chmura S J et al.. Long-term outcome of concurrent chemotherapy and reirradiation for recurrent and second primary head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 2005 Oct 3; , [Epub ahead of print]
- 19 Kelly K E, Anthony J P, Singer M. Pharyngoesophageal reconstruction using the radial forearm fasciocutaneous free flap: preliminary results. Otolaryngol Head Neck Surg. 1994; 111 16-24
Lawrence J GottliebM.D.
Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Chicago, 5841 S. Maryland Avenue, MC 6035, Chicago, IL 60637