TY - JOUR
T1 - Reconstruction of large pharyngeal defects with microvascular free flaps and myocutaneous pedicled flaps
AU - Welkoborsky, Hans J.
AU - Deichmüller, Cordula
AU - Bauer, Lothar
AU - Hinni, Michael L.
PY - 2013/8
Y1 - 2013/8
N2 - Purpose of Review: The current review will focus on the therapeutic options for reconstruction of large and complex defects of the oropharynx and hypopharynx, and the cervical esophagus following surgery for squamous cell carcinoma. The advantages and disadvantages of pedicled flaps, including the pectoralis major myocutaneous flap (PMMF) and supraclavicular artery flap (SAF), as well as the fasciocutaneous free flaps, including the radial forearm free flap (RFFF), the anterolateral thigh flap (ALT), and the jejunum free flap, are reviewed with particular emphasis on the literature from the past 2 years. Recent Findings: For partial pharyngeal defects, several reconstructive options, that is, PMMF, RFFF, SAF, and ALT might all be appropriate. When large mucosal surfaces need reconstruction, RFFF seems to be the most utilized. Nevertheless in reviewing the literature, no specific pedicled or free flap seems superior over other options. In cases of tongue reconstruction ALT or RFFF may be appropriate. After circumferential resections of the hypopharynx and cervical esophagus, free flaps achieve a significantly lower fistula and stricture rate compared to pedicled flaps with ALT and free jejunal flaps being used most commonly. However, donor-site morbidity and the complications of jejunal harvesting can be significant. Due to its great versatility, good reported functional and oncological outcomes, and reduced overall complication rate, the ALT flap warrants consideration. Finally, transoral robotic surgery (TORS) may provide future options for reconstruction. Summary: Currently the head and neck surgeon has a diverse armamentarium available to reconstruct even large and complex pharyngeal defects. Selecting the best reconstructive option must be individualized. Fasciocutaneous free flaps, that is, RFFF and especially ALT, are assuming a greater progressive role in pharyngeal reconstruction. TORS may eventually lead to new options for reconstructive surgery.
AB - Purpose of Review: The current review will focus on the therapeutic options for reconstruction of large and complex defects of the oropharynx and hypopharynx, and the cervical esophagus following surgery for squamous cell carcinoma. The advantages and disadvantages of pedicled flaps, including the pectoralis major myocutaneous flap (PMMF) and supraclavicular artery flap (SAF), as well as the fasciocutaneous free flaps, including the radial forearm free flap (RFFF), the anterolateral thigh flap (ALT), and the jejunum free flap, are reviewed with particular emphasis on the literature from the past 2 years. Recent Findings: For partial pharyngeal defects, several reconstructive options, that is, PMMF, RFFF, SAF, and ALT might all be appropriate. When large mucosal surfaces need reconstruction, RFFF seems to be the most utilized. Nevertheless in reviewing the literature, no specific pedicled or free flap seems superior over other options. In cases of tongue reconstruction ALT or RFFF may be appropriate. After circumferential resections of the hypopharynx and cervical esophagus, free flaps achieve a significantly lower fistula and stricture rate compared to pedicled flaps with ALT and free jejunal flaps being used most commonly. However, donor-site morbidity and the complications of jejunal harvesting can be significant. Due to its great versatility, good reported functional and oncological outcomes, and reduced overall complication rate, the ALT flap warrants consideration. Finally, transoral robotic surgery (TORS) may provide future options for reconstruction. Summary: Currently the head and neck surgeon has a diverse armamentarium available to reconstruct even large and complex pharyngeal defects. Selecting the best reconstructive option must be individualized. Fasciocutaneous free flaps, that is, RFFF and especially ALT, are assuming a greater progressive role in pharyngeal reconstruction. TORS may eventually lead to new options for reconstructive surgery.
KW - anterolateral thigh flap
KW - free flaps
KW - jejunum free flap
KW - pectoralis major myocutaneous flap
KW - pharyngeal defects
KW - radial forearm free flap
KW - reconstruction
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UR - http://www.scopus.com/inward/citedby.url?scp=84880916219&partnerID=8YFLogxK
U2 - 10.1097/MOO.0b013e3283631ea2
DO - 10.1097/MOO.0b013e3283631ea2
M3 - Review article
C2 - 23838547
AN - SCOPUS:84880916219
SN - 1068-9508
VL - 21
SP - 318
EP - 327
JO - Current Opinion in Otolaryngology and Head and Neck Surgery
JF - Current Opinion in Otolaryngology and Head and Neck Surgery
IS - 4
ER -