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Pedicled thoracoacromial artery compound flaps for circumferential hypopharyngeal reconstruction

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Background

Total laryngeal and hypopharyngeal resection remained to be the mainly treatment option for advanced hypopharyngeal cancer, which resulted in complicated reconstructive challenge for circumferential hypopharyngeal defect. The pedicled thoracoacromial artery compound flaps included Thoracoacromial artery perforator (TAAP) flap and pectoralis major myocutaneous (PMMC) flap. This study is to evaluate the clinical application of the pedicled thoracoacromial artery compound flaps for circumferential hypopharyngeal reconstruction.

Methods

From May 2021 to April 2022, four hypopharyngeal cancer patients with circumferential hypopharyngeal defects were reconstructed by the pedicled thoracoacromial artery compound flaps. All patients were males. Patient age ranged from 35 to 62 years (average, 50 years). The Shoulder function were evaluated by SPADI. The average follow-up was 10.25 months (range from 4 to 18 months).

Results

All of the pedicled thoracoacromial artery compound flaps in our study survived. The defect length between tongue base and cervical esophagus ranged from 8 to 10 cm after total laryngeal and hypopharyngeal resection. The TAAP flap size ranged from 6 × 7 cm to 7 × 10 cm, and the PMMC flap size ranged from 6 × 7 cm to 9 × 12 cm. The pedicle length of TAAP and PMMC flaps varied, respectively, from 5 to 8 cm (mean 6.5 cm) and 7 cm to 11 cm (mean 8.75 cm). The mean time of TAAP and PMMC flaps harvest was, respectively, 82 min and 39 min. All patients were able to resume soft diet in the fourth week of postoperation, but one patient was operated by gastrostomy in the second month of postoperation because of pharyngeal cavity stenosis, and the patient successfully resumed oral soft diet by endoscopic balloon dilation after postoperation radiotherapy. All patients have resumed oral feeding at last. There were mild dysfunction for our patients according to SPADI during the mid–long follow-up.

Conclusions

The pedicled thoracoacromial artery compound flaps have stable blood supply and provide adequate muscle coverage for greater protection during radiotherapy, and the microsurgical skills have no requirement. Therefore, the compound flaps provide a good choice for the reconstruction of circumferential hypopharyngeal defect, especially in the aged or patients with comorbidities who are not able to tolerate prolonged surgery.

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Data availability

The data sets presented in this article are not freely available because of patient confidentiality and participant privacy terms.

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Funding

The work was supported by the National Natural Science Foundation of Chongqing (cstc2020jcyj-msxmX1098) and the Joint Science and Health Project of Chongqing (2020FYYX221).

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Author notes

  1. Zhihai Wang and Wei Ma contributed equally to this study.

Authors and Affiliations

  1. Department of Otorhinolaryngology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China

    Zhihai Wang, Wei Ma, Xiaoqiang Wang, Quan Zeng & Guohua Hu

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  1. Zhihai Wang
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  2. Wei Ma
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  3. Xiaoqiang Wang
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  4. Quan Zeng
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  5. Guohua Hu
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Contributions

Conceptualization: ZW, GH. Methodology: ZW, QZ, GH. Data curation: WM, XW. Writing—original draft preparation: ZW, WM. Writing—review and editing, all authors. Visualization: ZW, GH. Supervision: GH. All authors contributed to the article and approved the submitted version.

Corresponding author

Correspondence to Guohua Hu.

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The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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This retrospective review of medical records was approved by the Institutional Review Board of the First Affiliated Hospital of Chongqing Medical University.

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Wang, Z., Ma, W., Wang, X. et al. Pedicled thoracoacromial artery compound flaps for circumferential hypopharyngeal reconstruction. Eur Arch Otorhinolaryngol 280, 4641–4647 (2023). https://doi.org/10.1007/s00405-023-08069-8

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  • DOI: https://doi.org/10.1007/s00405-023-08069-8

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