Sacchetto Andrea, Meneghesso Stefano, Mazzola Marco, Sacchetto Luca, Molteni Gabriele, Dallari Virginia
Department of Otolaryngology, Ospedale San Bortolo, AULSS 8 Berica, Vicenza, Italy.
Young Confederation of European ORL-HNS, Y-CEORL- HNS, Dublin, Ireland.
Eur Arch Otorhinolaryngol. 2025 May 14. doi: 10.1007/s00405-025-09456-z.
This article aims to review techniques and applications for using double flaps (both free and pedicled, and their combinations) in reconstructing defects from total pharyngolaryngectomies (TPL) or pharyngolaryngo-esophagectomies.
This systematic review followed PRISMA 2020 guidelines. Three authors screened articles, selecting and extracting data on malignancy characteristics, reconstructive techniques, outcomes and complications.
Eleven articles were reviewed, involving 176 oncologic patients. Most patients (39.8%) had defects in the larynx, hypopharynx and cervical skin, while in 31.8% the double flaps were used to restore the pharynx and protect the visceral anastomosis. In most studies included, preoperative treatments were administered, including radiotherapy (RT), concurrent chemoradiotherapy (CRT), and surgery, either alone or in combination. A wide variety of pedicled and free flaps were described. The most common pedicled flap is the pectoralis flap (81 patients, 46%), while the most used free flap is the jejunum flap (124 patients, 70%). 19 patients (10.8%) manifested partial necrosis or encountered minor complications postoperatively. 5 patients necessitated a surgical revision of the flap.
The literature on surgical reconstructions following TPL or pharyngolaryngo-esophagectomies using double flaps is limited. The use of double flap is indicated in cases of TPL with extensive skin defect but is also recommended in case of salvage TPL without skin defect.
本文旨在综述使用双皮瓣（游离皮瓣和带蒂皮瓣及其组合）重建全喉咽切除术（TPL）或喉咽食管切除术所致缺损的技术及应用。
本系统评价遵循PRISMA 2020指南。三位作者筛选文章，选择并提取有关恶性肿瘤特征、重建技术、结果及并发症的数据。
共纳入11篇文章，涉及176例肿瘤患者。大多数患者（39.8%）的缺损位于喉、下咽和颈部皮肤，31.8%的患者使用双皮瓣修复下咽并保护内脏吻合口。在纳入的大多数研究中，患者接受了术前治疗，包括放疗（RT）、同步放化疗（CRT）以及单独或联合进行的手术。文中描述了多种带蒂皮瓣和游离皮瓣。最常用的带蒂皮瓣是胸大肌皮瓣（81例患者，46%），最常用的游离皮瓣是空肠皮瓣（124例患者，70%）。19例患者（10.8%）术后出现部分坏死或出现轻微并发症。5例患者需要对皮瓣进行手术修复。
关于TPL或喉咽食管切除术后使用双皮瓣进行手术重建的文献有限。双皮瓣适用于皮肤缺损广泛的TPL病例，对于无皮肤缺损的挽救性TPL病例也推荐使用。
