Circumfertial pharyngeal reconstruction with an ALT Flap in Salvage cases - A case series

Introduction The ALT transplant is due to its variability and minimal donorsite morbidity along with a relatively large flap volume a well suited option to cover tissue defects of the head and neck. The option to cover different tissue defects of the inside and outside with a chimeric ALT ist a potential advantage in comparison to other transplants especially for circumferential pharyngeal defects after laryngopharyngectomy.

Methods Technical description of the reconstruction. Case series of patients with circumferential pharyngeal defects after laryngopharynectomy or total pharyngectomie with a salvage approach. Analysis of the flap sizes, the postoperative vitality of the flap, the development of pharyngeal fistulas and the ability to swallow.

Results We analysed 9 patients between the years 2017 and 2019 who underwent a circumferantial pharyngeal reconstruction with an ALT transplant. No revisions of the microvascular anastomosis was necessary and all transplants were vital. The sizes of the ALT measured between 9x9 cm and 9x15 cm. The wound closures of the donorsites were primarily in all cases. In 8/9 cases a chimeric ALT was used to cover a tissue defect of the cervical skin, additionally. 4/9 cases devoloped a fistula and underwent a surgical revision. Eventually, 8/9 patients had a pharyngeal passage of contrast agent without leckage.

Discussion The circumferential ALT transplant is a variable and reliable option for reconstruction in a salvage approach. Due to large flap sizes circumferential pharyngeal defects can be well covered to restore the passage for swallowing. In the short time of follow up no pharnygeal strictures were clinically noted.

Poster-PDF A-1925.PDF

Publication History

Article published online:
10 June 2020