Reconstruction of large pharyngeal defects with microvascular free flaps and myocutaneous pedicled flaps

Hans J. Welkoborsky, Cordula Deichmüller, Lothar Bauer, Michael L. Hinni

Research output: Contribution to journalReview article

26 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)318-327
Number of pages10
JournalCurrent Opinion in Otolaryngology and Head and Neck Surgery
Volume21
Issue number4
DOIs
StatePublished - Aug 1 2013

Keywords

  • anterolateral thigh flap
  • free flaps
  • jejunum free flap
  • pectoralis major myocutaneous flap
  • pharyngeal defects
  • radial forearm free flap
  • reconstruction

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

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