Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Head Neck. 2023 Dec;45(12):2996-3005. doi: 10.1002/hed.27526. Epub 2023 Sep 26.
Circumferential pharyngoesophageal defects resulting from total pharyngolaryngectomy are commonly reconstructed using free jejunal (FJ) transfer or an anterolateral thigh (ALT) free flap.
We reviewed the medical records of 92 patients with ALT free flaps and 140 who underwent FJ transfer between 2009 and 2022, and compared their surgical outcomes.
Total flap loss occurred in two (2%) and five (4%) patients in the ALT free flap and FJ transfer groups, respectively. Fistula rates were 5% in both groups. Stricture rates were 21% and 5% in the ALT free flap and FJ transfer groups, respectively (p < 0.01). At the 5-year follow-up evaluation, intelligible speech was achieved by 83% and 28% of patients (p < 0.01) in the ALT free flap and FJ transfer groups, respectively.
Each reconstructive method can be further optimized by proficient surgeons with expertise in the available methods and by considering patient-specific factors and available evidence.
全咽喉切除术导致的环形咽食管缺损通常采用游离空肠（FJ）移植或股前外侧皮瓣（ALT）游离皮瓣进行重建。
我们回顾了 2009 年至 2022 年间接受 ALT 游离皮瓣和 140 例 FJ 转移的 92 例患者的病历，并比较了他们的手术结果。
在 ALT 游离皮瓣和 FJ 转移组中，各有两例（2%）和五例（4%）患者发生全皮瓣坏死。两组瘘管发生率均为 5%。两组狭窄发生率分别为 21%和 5%（p<0.01）。在 5 年随访评估时，83%和 28%的 ALT 游离皮瓣和 FJ 转移组患者能够实现清晰的言语（p<0.01）。
熟练的外科医生可以通过精通现有方法，并考虑患者的具体因素和现有证据，进一步优化每种重建方法。
