One-stage reconstruction of complex pharyngoesophageal, tracheal, and anterior neck defects

Reconstruction of combined pharyngoesophageal, tracheal, and anterior neck defects is challenging and usually requires two flaps, which is sometimes accompanied by significant morbidity.

Between March of 2002 and February of 2004, 18 consecutive patients with combined defects of the pharynx and cervical esophagus, trachea, and/or anterior neck skin underwent reconstruction with a single anterolateral thigh flap. The skin paddle was divided into two islands based on separate cutaneous perforators in 10 patients. In the remaining patients with only one cutaneous perforator, a portion of the vastus lateralis muscle was included to support skin grafting for anterior neck resurfacing. The clinical, functional, and aesthetic outcomes of these patients were reviewed.

All of the patients experienced complete healing of reconstruction of their anterior neck and tracheal defects with good aesthetic results and only minor complications. The average hospital stay was 7 days. Four patients had a small fistula, which healed spontaneously in three patients but did not heal because of a local recurrence in the fourth. Two patients had a stricture requiring endoscopic dilatation. All but one patient without recurrence tolerated an oral diet.

Complex neck reconstruction can be accomplished with a single anterolateral thigh flap with good clinical and functional results, minimal morbidity, and quick recovery.