Larynx Preservation Surgery Revisited: A Case Series of Free-Flap Reconstructions for Various Laryngeal Compartments

Reconstruction after partial laryngectomy poses challenges in preserving voice, swallowing, and airway patency. Tailored laryngeal free-flap reconstructions using multiple chimeric perforator flaps aim to maximize functional preservation of the larynx and facilitate swallowing rehabilitation by enhancing larynx mobility.

Various compartmental laryngeal reconstructions using chimeric free flaps were performed on seven male patients (aged 40-82) with laryngeal malignancies following open partial laryngectomy. Chimeric anterolateral thigh (ALT) flaps and triple chimeric superficial circumflex iliac artery perforator (SCIP) flaps were each used in two patients, while three patients received chimeric medial femoral condyle perforator (MFCP) flaps. Patients were regularly monitored for tumor recurrence, airway patency, and voice and swallowing functions.

Postoperative courses were uneventful in all patients. Over a median follow-up of 30 months (range 9-41), five of seven patients were tracheostomy-independent, and four were on a full oral diet without a gastrostomy tube. Four patients had undergone prior radiotherapy, of whom two developed a second local recurrence, requiring total laryngectomy. One patient died from distant disease.

Following partial laryngectomy, compartment reconstruction with chimeric perforator flaps enhances larynx mobility, potentially improving functional outcomes. In the salvage setting, laryngeal preservation procedures may compromise oncological control. Further studies comparing the presented techniques with conventional reconstruction methods are warranted.