Radial Forearm Free Flap Pharyngoesophageal Reconstruction

Azizzadeh, Babak; Yafai, Sherry; Rawnsley, Jeffrey; Abemayor, Elliot; Sercarz, Joel A.; Calcaterra, Thomas C.; Berke, Gerald S.; Blackwell, Keith E.

doi:10.1097/00005537-200105000-00010

Cited by 110 publications

(94 citation statements)

References 21 publications

(31 reference statements)

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“…The radial forearm flap also has a reputation of having a high fistula rate, ranging from 17% to 50%. 15,16,32,33 Our series with the anterolateral thigh flap shows a fistula rate of 9%, which is more comparable to that with the jejunal flap. [11][12][13][14] We believe that an extra layer of closure with the fascia and sometimes the inclusion of a segment of the vastus lateralis muscle, which are unavailable with the radial forearm flap, may have contributed to the lower fistula rate of the anterolateral thigh flap.…”

Section: Discussionmentioning

confidence: 54%

Pharyngoesophageal reconstruction with the anterolateral thigh flap after total laryngopharyngectomy

Hanasono

Skoracki

et al. 2010

Cancer

158

144

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BACKGROUND: Pharyngoesophageal defects traditionally have been reconstructed using a jejunal or radial forearm flap. In 2002, the authors began using the anterolateral thigh flap for pharyngoesophageal reconstruction, and it has become our preferred method. The purpose of this study was to analyze the clinical and functional outcomes achieved using this technique. METHODS: The medical records of 91 male and 23 female patients who underwent pharyngoesophageal reconstruction using an anterolateral thigh flap were retrospectively reviewed. Outcomes analyzed included length of hospital and intensive care unit stay, fistula and anastomotic stricture formation and other complications, swallowing and tracheoesophageal speech function, and survival. Most patients had primary (27%) or recurrent (42%) squamous cell carcinoma. Before reconstruction, 71% of patients had undergone surgery, radiotherapy, or both. There were 67 circumferential and 47 near-circumferential defects. RESULTS: Mean intensive care unit stay was 1.9 AE 2.2 days, and mean hospital stay was 9.0 AE 4.7 days. Two patients experienced total flap loss, and 1 patient had partial flap necrosis. Pharyngocutaneous fistulas and strictures occurred in 9% and 6% of patients, respectively. Ninety-one percent of patients tolerated an oral diet without the need for tube feeding. Tracheoesophageal puncture was performed for speech rehabilitation in 51 patients. Eight-one percent of patients with a secondary tracheoesophageal puncture achieved fluent speech versus 41% of patients with a primary tracheoesophageal puncture. CONCLUSIONS: This series demonstrates that excellent clinical and functional outcomes, with minimal donor site morbidity and quick recovery, are possible with pharyngoesophageal reconstruction using an anterolateral thigh flap.

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Section: Discussionmentioning

confidence: 54%

Pharyngoesophageal reconstruction with the anterolateral thigh flap after total laryngopharyngectomy

Hanasono

Skoracki

et al. 2010

Cancer

158

144

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“…Reports of speech outcomes following radial forearm free flaps have been consistently good. 32,46 In a study by Scharpf and Esclamado,31 93% of patients were able to rely on tracheoesophageal puncture speech as their main modality of communication. In 1 study, although 63% of patients underwent TEP of the jejunal flap, only 25% of these patients went on to use it consistently for communication.…”

Section: Discussionmentioning

confidence: 99%

“…Perhaps this is the reason that reports of other types of fasciocutaneous reconstructions largely ignore 5,47 or do not expand 5,31,32 on the donor site complications. These studies quote 8% and 20% tendon exposure, respectively, following RFF harvest.…”

Section: Discussionmentioning

confidence: 99%

Functional outcomes and donor site morbidity following circumferential pharyngoesophageal reconstruction using an anterolateral thigh flap and salivary bypass tube

et al. 2006

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“…The tubed free radial forearm flap has also been frequently used for the same indications. [27][28][29] The discussion about the ideal method for reconstruction of the cervical oesophagus is still ongoing. 27,29,30 However, a high success and low complication rate has been reported for both methods.…”

Section: Discussionmentioning

confidence: 99%

“…27,29,30 However, a high success and low complication rate has been reported for both methods. [22][23][24][25][26][27][28][29] The lateral island trapezius myocutaneous flap, 31 the extended submental island flap, 32 and the pectoralis major myocutaneous flap 33,34 are reported to be alternative methods for cervical oesophageal reconstruction, and might be suitable also in trauma situations. However, the data available on these procedures for the particular indication of post-traumatic oesophageal repair are limited.…”

Section: Discussionmentioning

confidence: 99%

Use of a free jejunal graft for oesophageal reconstruction following perforation after cervical spine surgery: case report and review of the literature

Erdmann

et al. 2003

Spinal Cord

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Study design: Single-subject (male, 16 years of age) case. Objectives: To demonstrate a suitable method for oesophageal repair after perforation as a complication of anterior spinal fusion in an individual with quadriplegia, and to review the literature on oesophageal perforation and repair. Setting: University hospital, large trauma centre with departments for spinal injuries and reconstructive surgery in Germany. Methods: A free jejunal graft used for oesophageal reconstruction in a post-traumatic situation after a complicated treatment course in a C6 quadriplegic patient. Results: A protuberant loose screw of the titanium plate after anterior spinal fusion perforated the oesophagus. Imbricating sutures and a fascia lata patch were insufficient to repair the oesophageal leakage. An 8 cm long segment of the cervical oesophagus including a fistula had to be excised, and a free microsurgical jejunal flap was used for restitution of continuity. The jejunal vessels were connected to the superior thyroid artery and external jugular vein. At 1 week after the oesophageal repair, an enteral contrast study showed a small amount of contrast medium leaking at the oesophago-pharyngeal anastomosis. A percutaneous gastric tube was inserted, and oral feeding was limited to tea and still water for 4 weeks. The further course was uneventful. Conclusions: Oesophageal perforation is a rare but recognized complication after cervical spine surgery, which can mostly be managed using secondary suture techniques. The free jejunal flap is a reliable and innovative tool in the particularly complex situation of a segmental oesophageal loss. It should be considered in similar cases to reconstruct oesophageal continuity or to treat stricture and fistula formations.

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Radial Forearm Free Flap Pharyngoesophageal Reconstruction

Cited by 110 publications

References 21 publications

Pharyngoesophageal reconstruction with the anterolateral thigh flap after total laryngopharyngectomy

Pharyngoesophageal reconstruction with the anterolateral thigh flap after total laryngopharyngectomy

Functional outcomes and donor site morbidity following circumferential pharyngoesophageal reconstruction using an anterolateral thigh flap and salivary bypass tube

Use of a free jejunal graft for oesophageal reconstruction following perforation after cervical spine surgery: case report and review of the literature

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