The antero-lateral thigh (ALT) flap as a plastic-reconstructive method insalvage surgery in the head and neck region

Introduction The antero-lateral thigh (ALT) flap is a well-established method in plastic-reconstructive surgery of the head and neck region.

Case history We report on a patient who dealt with a new swelling with skin erythema on the right in the area of the cervicothoracic junction. There was a condition after neck lymph node removal on the right side alio loco.

Histologically a non-small-cell cancer showed a stronger profile that was a malignant tumor with regressive necrobiotic accompanying changes. In the panendoscopy and PET-CT there was also no evidence for a primary origin. Despite the recommendation of the interdisciplinary head and neck tumor board for primary surgical therapy the patient decided to undergo a combined radiochemotherapy for CUP syndrome.

However, the patient showed up 6 weeks after the end of the primary radiochemotherapy with a residual tumor. During the followingimmunotherapy alio loco using Durvalumab the tumor showed progression. At the request of the patient a salvage operation on the cervical right with partial resection of the trapezius muscle, sternocleideomastoideus muscle and accessorius nerve was performed.

A 12 × 4 × 5 cm ALT flap from the right side was used to reconstruct the defect.

The intra- and postoperative course was without complications. The patient has been free of recurrence for 15 months.

Conclusion The postradiogenic surgical site in the head and neck region is a surgical challenge in salvage surgery. In case of therapy failure of primary radiochemotherapy the ALT flap is still a possible method for reconstruction of large-volume defects in the head and neck region.

Cantemir, Eichhorn, Park

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Artikel online veröffentlicht:
24. Mai 2022