Buried anterolateral thigh flap for pharyngoesophageal reconstruction: Our method for monitoring

Abstract

The proposed method of monitoring is simple, reliable, costless, and easily interpreted by the nursing staff.

The free inverted omega‐shaped flap for circumferential hypopharyngeal reconstruction with simultaneous neck skin defect

“…The fistula rate for our series was 21.4%, which is comparable to Sagar et al (25%), but higher than Huang et al (17.8%); Yu et al (17%); and Spyropoulou et al (18%). But for these above‐mentioned publications, the defects reconstructed included both patch and tubular defects.…”

“…However, with the use of jejunal flap, based on different literatures, it has an internal diameter of 2.5 cm (circumference = π × diameter = 7.85 cm) or 3–5 cm (circumference: 9.4–15.7 cm). In the previously reported spiral ALT tubing design, a 50 ml syringe was used as a template to create a uniform tubular structure with a diameter of 3 cm, which has a circumference of 9.4 cm. The mismatches of the diameter from the flap used for reconstruction, whether it is a jejunal flap or a spiral ALT tubing flap, are prone to food passage hindrance.…”

“…With the use of jejunal flap and radial forearm flap, there is no extra soft tissue for neck skin defect reconstruction. As for the spiral ALT tubing design, unless a well‐positioned second or third cutaneous perforators can be found, simultaneous circumferential hypopharyngeal defect and neck skin defect cannot be achieved . A second free flap or a loco‐regional flap is often required to reconstruct such neck defect.…”

“…The flap harvesting was carried out as usual, notably the distal end of descending branch from the LCFA was dissected distally for approximately 3 cm from the most distal perforator before ligation. This stump was externalized on the neck skin as a monitoring stump for a direct visualization of the pulsation from the stump, which indicated anastomosis patency . The stump was covered with a transparent dressing (OpSite; Smith‐Nephew Healthcare Limited; London, United Kingdom) to allow visualization of the stump pulsation and to avoid desiccation.…”

Anterolateral Thigh Flap

“…This allows identification and protection of a skin perforator situated laterally. 25,26 Early detection of vascular compromise is essential to prevent the "no-reflow" phenomenon, which will occur within 8 to 12 hours of ischemia. The fasciocutaneous flap is retracted laterally and the dominant perforator identified.…”