Ignacio Lugo Beltran, Marisol Guitian González, Cristina Ornelas-Flores María, Armando Uribe Briceño David, Fernando Delcid Morazán Allan
Plastic and Reconstructive Surgery Department at Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico.
World J Plast Surg. 2024;13(2):77-81. doi: 10.61186/wjps.13.2.77.
Hypopharyngeal carcinoma is one of the most aggressive primary head and neck cancers, often managed through partial or total laryngopharyngectomy. Reconstruction after such surgeries remains a challenging procedure that often requires the use of free flaps. A 63-year-old male patient with in-situ squamous cell carcinoma of the left vocal cord treated with total pharyngolaryngectomy and primary reconstruction with a left radial forearm free flap, complicated by flap necrosis, which ended up in dismantling and gastrostomy. He was referred to the Plastic and Reconstructive Surgery Department at Centro Medico Nacional 20 de Noviembre, Mexico in 2023 to assess the reconstructive options for the hypopharynx and cervical esophagus defect. A tubular right radial forearm free flap was designed forming the anterior wall of the hypopharynx and cervical esophagus and a posterior wall for the external defect. Twelve months after his surgery, he continues tolerating oral intake without signs of stenosis or tumor recurrence. The objective in this case was based on restoring the continuity of the digestive tract and swallowing function, as well as providing skin coverage of the defects, and preventing serious complications. The radial forearm free flap has versatility in the tubular construction and a low leak rate, as well as an adequate skin island size. Conclusion: The pharyngoesophageal reconstruction with a tubed forearm free flap has favorable outcomes for restoring the gastrointestinal tract without further complications.
下咽癌是最具侵袭性的原发性头颈部癌症之一，通常通过部分或全喉咽切除术进行治疗。此类手术后的重建仍然是一项具有挑战性的手术，通常需要使用游离皮瓣。一名63岁男性患者，患有左侧声带原位鳞状细胞癌，接受了全喉咽切除术，并采用左侧桡侧前臂游离皮瓣进行一期重建，术后出现皮瓣坏死并发症，最终导致皮瓣拆除和胃造口术。2023年，他被转诊至墨西哥国立20 de Noviembre医学中心的整形与重建外科，以评估下咽和颈段食管缺损的重建方案。设计了一个管状右侧桡侧前臂游离皮瓣，形成下咽和颈段食管的前壁以及外部缺损的后壁。手术12个月后，他继续能够耐受经口进食，没有狭窄或肿瘤复发的迹象。该病例的目标是恢复消化道的连续性和吞咽功能，以及为缺损提供皮肤覆盖，并预防严重并发症。桡侧前臂游离皮瓣在管状构建方面具有多功能性，漏率低，且皮岛大小合适。结论：采用带蒂前臂游离皮瓣进行咽食管重建，在恢复胃肠道功能方面具有良好效果，且无进一步并发症。
