Pharynx and Trachea Reconstruction with Pedicle and Fasciocutaneous Flap: A Clinical Case
Journal: Advances in Medicine and Engineering Interdisciplinary Research DOI: 10.32629/ameir.v3i1.3727
Abstract
Objective: This study aims to present a clinical case requiring pharynx and trachea reconstruction using a transverse cervical artery-based perforator flap, and an internal mammary perforators-based fasciocutaneous flap, for managing complex post-laryngectomy fistula. Clinical case: The case we describe is of a 62-year-old patient with squamous cell carcinoma of the glottic larynx, who after radiotherapy and total laryngectomy presented a pharynx-to-skin and pharynx-to-trachea fistula--. He underwent surgery with a perforated flap based on a branch of the transverse cervical artery and another fasciocutaneous flap based on internal mammary perforators. Conclusion: Pedicled perforated flaps are quick to dissect, safe, thin, versatile, and offer a functional reconstruction similar to a microsurgical flap. Head and neck reconstruction can be challenging due to comorbidities and previous radiotherapy. A notable advantage is that tissue harvested from an area near the defect is generally more similar than tissue harvested from another donor site. Dissection of the cervix or microsurgical anastomoses are not required.
Keywords
carcinoma; squamous cell; fistula; larynx; trachea; flaps
Full Text
PDF - Viewed/Downloaded: 0 TimesReferences
[1] Mata F, Agudo E, Canela C, García Colina J, Manzo A, Rodríguez A, et al. Consenso nacional sobre cáncer de laringe. Diagnóstico y tratamiento. Rev Venez Oncol. 2012;24(1):64-95.
[2] Shah J. En: Head and neck surgery and oncology. Shah J, editor. Larynx and Trachea. ELSEIVER. 5. edición. 2020. p. 365-439.
[3] Wang M, Xun Y, Wang K, Lu L, Yu A, Guan B, et al. Risk factors of pharyngocutaneous fistula after total laryngectomy: a systematic review and metaanalysis. Eur Arch Otorhinolaryngoly. 2020;277(2):585-599.
[4] Hu S, Fan C, Pecchia B, Rosenberg J. Submental island flap vs free tissue transfer in oral cavity reconstruction. Head Neck. 2020;42(8):2155-2164.
[5] Correa D, García H, Márquez C, Rodríguez J, Terán D, Torres T, et al. Colgajos de perforantes: principios básicos y aplicaciones clínicas. Rev Fac Med. 2012;20(1):42-51.
[6] Locatello L, Licci G, Maggiore G, Gallo O. J. Review non-surgical strategies for assisting closure of pharyngocutaneous fistula after total laryngectomy: a systematic review of the literature. Clin Med. 2022;11:100.
[7] Wang L, Ma C, Shen Y, Fang J, Haugen T, Guo B, et al. Transverse cervical artery anterior perforator flap for oncological reconstruction of the head and neck. Head Neck. 2021;43(11):3598-3607.
[8] Chang T, Chang C, Tang W, Lee W, Lee Y, Huang W, et al. Healing the gap: the evolution of esophageal substitute and quality of life in patients undergoing total pharyngolaryngoesophagectomy with reconstruction. Plast Aesthet Res. 2021;8:29.
[9] Scaglioni M, Meroni M, Fritsche E, Rajan G. Superficial circumflex iliac artery perforator flap in advanced head and neck reconstruction: from simple to its chimeric patterns and clinical experience with 22 Cases. Plast Reconstr Surg. 2022:1;149(3):721-730.
[2] Shah J. En: Head and neck surgery and oncology. Shah J, editor. Larynx and Trachea. ELSEIVER. 5. edición. 2020. p. 365-439.
[3] Wang M, Xun Y, Wang K, Lu L, Yu A, Guan B, et al. Risk factors of pharyngocutaneous fistula after total laryngectomy: a systematic review and metaanalysis. Eur Arch Otorhinolaryngoly. 2020;277(2):585-599.
[4] Hu S, Fan C, Pecchia B, Rosenberg J. Submental island flap vs free tissue transfer in oral cavity reconstruction. Head Neck. 2020;42(8):2155-2164.
[5] Correa D, García H, Márquez C, Rodríguez J, Terán D, Torres T, et al. Colgajos de perforantes: principios básicos y aplicaciones clínicas. Rev Fac Med. 2012;20(1):42-51.
[6] Locatello L, Licci G, Maggiore G, Gallo O. J. Review non-surgical strategies for assisting closure of pharyngocutaneous fistula after total laryngectomy: a systematic review of the literature. Clin Med. 2022;11:100.
[7] Wang L, Ma C, Shen Y, Fang J, Haugen T, Guo B, et al. Transverse cervical artery anterior perforator flap for oncological reconstruction of the head and neck. Head Neck. 2021;43(11):3598-3607.
[8] Chang T, Chang C, Tang W, Lee W, Lee Y, Huang W, et al. Healing the gap: the evolution of esophageal substitute and quality of life in patients undergoing total pharyngolaryngoesophagectomy with reconstruction. Plast Aesthet Res. 2021;8:29.
[9] Scaglioni M, Meroni M, Fritsche E, Rajan G. Superficial circumflex iliac artery perforator flap in advanced head and neck reconstruction: from simple to its chimeric patterns and clinical experience with 22 Cases. Plast Reconstr Surg. 2022:1;149(3):721-730.
Copyright © 2025 Alirio Mijares Briñez, Carmen Suárez, Alberto Pérez M, Alexandra Franco, Diana Pérez, Karen Díaz
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
