The short head of the biceps femoris as a monitor for the free lateral thigh flap in pharyngoesophageal reconstruction

Lateral Thigh Free Flap With Flow-Through Vascular Pedicle

“…This muscle is thin and can be raised with the flap for bulk or as a monitoring buoy in buried flaps. 17 The flap dissection is slightly more difficult than medial thigh flap or ALT. 18 The most difficult part of dissection is to ligate the muscular branches to the vastus lateralis and the adductor magnus which are very close to the hiatus where it perforates the adductor magnus.…”

“…The flap can be raised as a skin flap 1 or fasciocutaneous flap. [2][3][4][5]22 The addition of the biceps femoris short head can add bulk or be used for monitoring flap viability in buried flaps, 17 and can therefore be used for a variety of situations both in limb reconstruction and in head and neck reconstruction. Thinning is possible after the flap has been reperfused at the recipient site (as was done in case 5).…”

Pharyngoesophageal reconstruction with lateral thigh free flap

“…17 The third and fourth perforators of the profunda femoris artery, the main vascular pedicle of the lateral thigh flap, pass through the short head of the biceps femoris and have large consistent muscular branches. 11,12,14,17 Part of the biceps femoris can be safely included in the principal vascular pedicle without prolonging the operation time or requiring difficult extra dissection. The viability of the neopharyngoesophagus was monitored by observing the exposed muscle through a small window in the neck, which shares the vascular pedicle with the main flap.…”

“…In addition, the exposed short head of the biceps femoris muscle can be used to protect the carotid artery and to obliterate the dead space. 17 Hayden and Derscher 14 used a separate skin island to be incorporated into the cervical closure for lateral thigh free flap monitoring.…”

“…To avoid pedicle trauma during mobilization, a cuff of the short head of the biceps femoris muscle can be taken 14 and can be used as a monitor for the flap. 17 Truelson and Leach 15 reported 4 cases of flap loss in 33 cases and listed hematoma, neck infection, twisted pedicle, and fistula as the predisposing causes. Hayden and Descher 14 noted 1 flap failure in 58 flaps (1.7%), which was related to venous thrombosis.…”