Pedicled thoracoacromial artery compound flaps for circumferential hypopharyngeal reconstruction

作者全名："Wang, Zhihai; Ma, Wei; Wang, Xiaoqiang; Zeng, Quan; Hu, Guohua"

作者地址："[Wang, Zhihai; Ma, Wei; Wang, Xiaoqiang; Zeng, Quan; Hu, Guohua] Chongqing Med Univ, Affiliated Hosp 1, Dept Otorhinolaryngol, Chongqing 400016, Peoples R China"

通信作者："Hu, GH (通讯作者)，Chongqing Med Univ, Affiliated Hosp 1, Dept Otorhinolaryngol, Chongqing 400016, Peoples R China."

来源：EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001021382600003

JCR分区：Q2

影响因子：1.9

年份：2023

卷号：　

期号：　

开始页：　

结束页：　

文献类型：Article; Early Access

关键词：Circumferential pharyngoesophageal reconstruction; Perforator flap; Thoracoacromial artery perforator flap; Pectoralis major myocutaneous flap

摘要："BackgroundTotal 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.MethodsFrom 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).ResultsAll 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 x 7 cm to 7 x 10 cm, and the PMMC flap size ranged from 6 x 7 cm to 9 x 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.ConclusionsThe 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."

基金机构：National Natural Science Foundation of Chongqing [cstc2020jcyj-msxmX1098]; Joint Science and Health Project of Chongqing [2020FYYX221]

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