Closing of large pharyngostomes with free flaps and proposal of a new classification

Perforator‐based chimeric anterolateral thigh flap U‐shaped insetting for total pharyngoesophageal reconstruction: Surgical technique and functional outcomes

“…Indeed, in our series, fiberoptic laryngoscopy showed a greater amount of fibrosis in patients who received adjuvant radiotherapy (Figure 7). Evidence in literature about the functional outcomes associated to this insetting approach applied to the ALT flap is limited (Llorente et al, 2020;Piazza et al, 2012;Piazza et al, 2017) with no data concerning the impact of patients' voice and swallowing function on their quality of life postoperatively. This series documents the safety and efficacy of the U-shaped ALT flap insetting in hypopharyngeal reconstruction.…”

“…Total pharyngolaryngectomy for cancer resection, is an invasive procedure which leaves the patient with a significant morbidity and limited long‐term survival outcomes (Llorente et al, 2020). In these patients, restoring anatomy and function is a challenge which requires a viable and versatile flap with minimal donor site morbidity, resistant to strictures and stenosis, which allows patients to achieve good swallowing and speech functions and relatively low fistula and anastomotic leakage complications (Yu et al, 2010).…”

“…The U‐shaped insetting, which consists in suturing the lateral edges of the flap to the prevertebral fascia, was described for the pectoralis major musculocutaneous flap (Espitalier et al, 2012; Leon et al, 1999; Morshed et al, 2005; Spriano et al, 2001), radial forearm flap (Bootz et al, 2002; Varvares et al, 2000) and ALT flap (Piazza et al, 2017; Piazza et al, 2021) with a reported lower incidence in PCF and strictures (Leon et al, 1999; Piazza et al, 2012; Varvares et al, 2000). Available literature about the functional outcomes associated to this insetting applied to the ALT flap is limited (Llorente et al, 2020; Piazza et al, 2012; Piazza et al, 2017) with no data concerning the impact of patients' voice and swallowing function on their quality of life postoperatively. We present our experience with the U‐shaped insetting of ALT flap for pharyngoesophageal reconstruction describing the surgical technique, reporting complications and functional outcomes.…”