From the Department of Otolaryngology Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Ann Plast Surg. 2024 Mar 1;92(3):300-305. doi: 10.1097/SAP.0000000000003767. Epub 2024 Jan 4.
Patients with local advanced hypopharyngeal combined with esophageal cancer often require total laryngectomy and cervical esophagectomy, which result in big-sized upper aerodigestive tract defects and neck deformities. Although free flap is widely used to reconstruct aerodigestive defects, the aesthetic results especially that of neck contour have not brought to the forefront or discussed extensively. This article aims to report the preliminary aesthetic results of free flap reconstruction for local advanced hypopharyngeal cancer combined with cervical esophageal cancer defects, highlighting the thickness of subcutaneous fat of the flap.
A retrospective study of 21 patients with local advanced hypopharyngeal combined with cervical esophageal cancer from July 2010 to August 2022 was conducted. After completing total laryngectomy, bilateral neck dissection, and removal of the tumor with safe margin, a free thigh flap of subcutaneous fat greater than 1 cm in thickness was used to reconstruct the hypopharyngeal and cervical esophageal defects. In addition to general demographic, oncological, and reconstructive data, preoperative and postoperative neck circumferences were recorded and compared. A subjective questionnaire survey was conducted on patients' satisfaction with postoperative neck contour. The patients were followed up from 3 to 10 years, with an average of 3 years.
There were 2 cases (2/21) of free flap loss because of flap necrosis and secondary repair with a pedicled pectoralis major flap. Nineteen flaps (19/21) survived. Three cases (3/21) developed a pharyngeal fistula and one case (1/21) experienced salivary fistula, all of the fistulae healed after drainage and dressing change. There was a relatively high satisfaction rate among patients (16/21) with the postoperative neck contour. A paired sample t test showed no statistically significant difference between the preoperative and postoperative values ( t = 2.002, P > 0.05). Patients with a thicker subcutaneous fat flap (≥1.5 cm) had a more symmetrical and fuller neck contour during long-term postoperative follow-up.
The application of a fat-rich subcutaneous free thigh flap to reconstruct the defect of local advanced hypopharyngeal combined with cervical esophageal cancer can achieve better neck aesthetic contour.
局部晚期下咽合并食管上段癌患者常需行全喉切除及颈段食管切除，导致上气道及颈部较大范围的组织缺损和畸形。游离皮瓣在重建下咽及颈段食管缺损中应用广泛，但皮瓣的皮下脂肪厚度对术后颈颏部美观效果的影响尚未引起关注。本文旨在报道游离皮瓣修复下咽颈段食管癌术后缺损的初步美学效果，重点关注皮瓣的皮下脂肪厚度。
回顾性分析 2010 年 7 月至 2022 年 8 月收治的 21 例局部晚期下咽合并颈段食管上段癌患者，全喉切除+双侧颈清扫+安全切缘肿瘤切除后，应用带 1cm 以上皮下脂肪厚度的股前外侧游离皮瓣修复下咽颈段食管缺损。记录并比较患者术前、术后颈围，同时对患者术后颈颏部外形满意度进行问卷调查。随访 3 ～ 10 年，平均 3 年。
21 例患者中，2 例（2/21）游离皮瓣因血管危象导致皮瓣坏死，二期行带蒂胸大肌皮瓣修复；19 例（19/21）皮瓣存活。术后 3 例（3/21）发生咽瘘，1 例（1/21）发生涎瘘，经引流及换药后愈合。16 例（16/21）患者对术后颈颏部外形满意度较高。配对样本 t 检验结果显示，患者术前、术后颈围差异无统计学意义（ t =2.002， P >0.05）。术后长期随访中，皮瓣皮下脂肪厚度较厚（≥1.5cm）的患者颈颏部外形更加对称饱满。
游离股前外侧皮瓣修复下咽颈段食管癌术后缺损可获得较好的颈颏部外形，皮瓣的皮下脂肪厚度对颈颏部美观效果有重要影响。
