A flag-shaped anterolateral thigh free flap for complete circumferential hypopharyngeal reconstruction with dead space obliteration and monitoring flap inset

Background: The challenging issues are to prevent anastomotic leakage and provide sufficient flap monitoring in circumferential hypopharyngeal reconstruction. In this study, a newly designed flag-shaped anterolateral thigh (ALT) free flap was used for circumferential hypopharyngeal reconstruction to address these issues. Methods: Eighteen ALT flaps were harvested for reconstruction of circumferential hypopharyngeal defects from 2013 to 2016. The harvested ALT flap was sutured into a cylinder shape, and a triangular extension of the flap was used for dead space obliteration and flap monitoring. All data regarding outcomes and complications including radiographic investigations were collected retrospectively. Results: The flap had a rectangular shape with dimensions of 29 cm x 8 cm (range, 25-31 cm x 6-10 cm). For each flap, 2-4 perforators were included (average, 2.6 perforators/flap). All flaps survived. One venous thrombosis was diagnosed early through the monitoring portion of the flap, and the flap was salvaged after thrombectomy with a vein graft. The mean follow-up period was 28.9 months (10.3). There was one case of definitive fistula (4%), which never healed because of early tumor recurrence. Three postoperative strictures were noted (21.4%). Conclusions: For a complete circumferential hypopharyngeal defect, the flag-shaped ALT free flap design offers monitoring flap and dead space obliteration and prevents anastomotic leakage. (C) 2019 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.