Safe and Time-Saving Method for Pharyngeal Reconstruction Using an Internal Mammary Artery Perforator Flap

Area of Science:

• Reconstructive surgery
• Oncology
• Vascular surgery

Background:

• Head and neck squamous cell carcinoma frequently necessitates total laryngectomy (TL), leading to complex pharyngeal defects.
• Reconstruction in irradiated patients poses challenges due to compromised tissue vascularity.
• The internal mammary artery perforator (IMAP) flap presents a viable option, but its outcomes in irradiated post-TL patients require further elucidation.

Purpose of the Study:

• To evaluate the safety and efficacy of the IMAP flap for laryngeal defect reconstruction in patients who have undergone total laryngectomy and prior radiotherapy.
• To assess flap survival rates, complication profiles, and functional outcomes in this specific patient cohort.

Main Methods:

• A retrospective analysis of seven patients who received IMAP flap reconstruction following TL for advanced laryngeal carcinoma.
• All patients had a history of radiotherapy.
• Flap design utilized Doppler ultrasound, with the second intercostal space IMAP predominantly used.
• Surgical time, defect coverage, complications, and hospital stay were recorded.

Main Results:

• The average surgical time for flap elevation was 61 minutes.
• Full coverage of pharyngeal defects (average size 4.57 cm²) was achieved in all patients.
• The mean hospital stay was 4 days.
• A 100% flap survival rate was observed with no instances of flap necrosis or fistulas at 3 months.
• One patient experienced a postoperative hematoma, representing the sole complication.

Conclusions:

• The IMAP flap is a safe and effective reconstructive choice for laryngeal defects in irradiated patients post-total laryngectomy.
• It demonstrates excellent viability, favorable aesthetics, reduced morbidity, and minimal complications.
• The thin, elongated IMAP flap design, supported by constant blood flow, yields reliable results.