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Functional outcomes after circumferential pharyngoesophageal reconstruction
Jan S Lewin1, Denise A Barringer, Annette H May
1Department of Head and Neck Surgery, Section of Speech Pathology and Audiology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas 77030, USA. jlewin@mdanderson.org
The Laryngoscope
|July 5, 2005
Summary
The anterolateral thigh (ALT) flap offers comparable complication rates to jejunal flaps for pharyngoesophageal reconstruction. ALT flaps demonstrate superior outcomes in speech and swallowing function, with shorter intensive care unit (ICU) and hospital stays.
Area of Science:
- Head and Neck Surgery
- Reconstructive Surgery
- Otolaryngology
Background:
- Circumferential pharyngoesophageal defects require complex reconstruction.
- Jejunal flaps have been a traditional choice for such reconstructions.
- Alternative flap options are being explored to improve functional outcomes.
Purpose of the Study:
- To compare functional speech and swallowing outcomes between anterolateral thigh (ALT) flaps and jejunal flaps for pharyngoesophageal reconstruction.
- To evaluate morbidity and complication rates associated with each flap type.
Main Methods:
- Retrospective analysis of 58 patients with circumferential pharyngoesophageal defects.
- Comparison of 27 patients who underwent ALT flap reconstruction versus 31 patients who had jejunal interposition.
- Assessment of complication rates, length of stay, nutritional intake, tracheoesophageal puncture (TEP) use, speech fluency, and swallowing physiology via modified barium swallow studies.
Main Results:
- Similar complication rates (flap loss, fistula, anastomotic stricture) were observed between ALT and jejunal flaps.
- Jejunal reconstruction was associated with significantly longer intensive care unit (ICU) and hospital stays.
- ALT flap reconstruction resulted in better speech fluency (89% vs. 63%) and functional speech use (78% vs. 25%), as well as a higher rate of resumed oral intake (91% vs. 73%).
Conclusions:
- The anterolateral thigh (ALT) flap is a viable alternative to jejunal flaps for circumferential pharyngoesophageal reconstruction.
- ALT flaps provide comparable safety profiles regarding complications.
- ALT flaps offer significant advantages in terms of reduced hospital stay and improved functional speech and swallowing outcomes.