Single-stage reconstruction of composite central neck defects with the double-island vertical rectus abdominis...

A subset of patients with hypopharyngeal cancer has tumors involving the neck skin and soft tissues in addition to vital structures such as the larynx and alimentary tract. Surgical extirpation creates a complex composite deformity for the reconstructive surgeon. The objective of this article is to describe the rationale for closure of these defects with the double-island vertical rectus abdominis musculocutaneous (VRAM) flap.

Retrospective chart review of all head and neck reconstructions performed over the past 20 years identified 4 patients who underwent reconstruction of combined defects involving less than 50% of the pharyngoesophageal circumference and anterior neck soft tissues. All wounds were closed in a single-stage with a double-island VRAM. Outcomes and complications were reviewed.

Indication for resection was locally advanced disease or recurrence with pharyngocutaneous fistula. Mean age was 54 years with a follow-up time of 2 years. The average external skin defect measured 10 × 15 cm. There was no complete or partial flap loss. No major and 2 minor complications were identified. All patients tolerated an oral diet postoperatively. No revisions have been performed.

In contrast to perforator flaps where creation of separate skin paddles may not always be possible, the VRAM's robust axial blood supply facilitates formation of 2 independent skin islands in all cases. The external island serves as a flap monitor and obviates the need for a second flap. In conclusion, the double-island VRAM flap is safe, has minimal donor-site morbidity, and reliably accomplishes reconstruction of composite head and neck defects in a single-stage.