Queen Elizabeth Hospital, Birmingham B15 2TH, United Kingdom.
Plastic Surgery Department, Royal Victoria Infirmary, Newcastle-upon-Tyne NE1 4LP, United Kingdom.
J Plast Reconstr Aesthet Surg. 2021 Jun;74(6):1355-1401. doi: 10.1016/j.bjps.2020.11.029. Epub 2020 Dec 13.
Previous reports have demonstrated good outcomes with the use of the Anterolateral Thigh Flap (ALT) in pharyngeal reconstruction. We report a new modification of free ALT flap pharyngeal reconstruction utilizing vascularised fascial wings or extensions placed in the parastomal gutters to cover the major neck vessels.
This was a single-center retrospective case review. Between November 2017 and January 2019, 8 patients (6 male, 2 female mean age 61, range 35 to 74) underwent near circumferential pharyngeal reconstruction by the modified technique. 3 patients had laryngopharyngectomy for radiorecurrent larynx SCC, 2 for primary, advanced laryngeal SCC, and 3 for primary hypopharyngeal SCC.
All eight patients regained adequate swallow to maintain nutrition without tube-feeding. Two of the patients have been assessed as appropriate for tracheo-esophageal puncture and are awaiting placement. One patient uses an electrolarynx for speech and 5 patients aphonic only. One patient died 2 months after the procedure from chest infection. There were no flap failures, no fistulas and no strictures at one year. One patient who underwent a salvage laryngopharyngectomy experienced parastomal wound dehiscence, but critically there was no return to theater for exposed major vessels and the wound healed within 6 weeks requiring dressings only.
Here we report outcomes of pharyngeal reconstruction with a modified single perforator free ALT flap using fascial extensions to line the parastomal gutters. In the event of parastomal dehiscence, the placement of vascularized tissue parastomally may facilitate spontaneous healing and prevent major vessel exposure.
先前的报告表明，使用前外侧股薄肌皮瓣（ALT）进行咽重建的效果良好。我们报告了一种新的改良游离 ALT 皮瓣咽重建技术，利用血管化筋膜翼或延伸部放置在吻合口旁肠腔中，以覆盖主要颈部血管。
这是一项单中心回顾性病例研究。在 2017 年 11 月至 2019 年 1 月期间，8 例患者（6 例男性，2 例女性；平均年龄 61 岁，范围 35 至 74 岁）接受了改良技术的近环咽重建。3 例患者因喉复发 SCC 行喉咽切除术，2 例因原发性、晚期喉 SCC，3 例因原发性下咽 SCC。
所有 8 例患者均恢复了足够的吞咽功能，无需管饲维持营养。2 例患者已被评估为适合进行气管食管造口术，正在等待安置。1 例患者使用电子喉进行言语，5 例患者仅失音。1 例患者在术后 2 个月因胸部感染死亡。1 年内无皮瓣失败、瘘管和狭窄。1 例接受挽救性喉咽切除术的患者出现吻合口旁伤口裂开，但关键是没有返回手术室处理暴露的主要血管，伤口在 6 周内自行愈合，仅需敷料。
在这里，我们报告了使用改良的单穿支游离 ALT 皮瓣和筋膜延伸物来覆盖吻合口旁肠腔的咽重建结果。在吻合口旁裂开的情况下，吻合口旁放置血管化组织可能有助于自发愈合并防止主要血管暴露。
