Chimeric thoracodorsal free flap reconstruction for extended circumferential pharyngo-laryngectomy: A case report

Circumferential pharyngolaryngectomy (CPL) may result in extensive posterior pharyngeal defects for which standard reconstructive strategies are insufficient. Chimeric flaps from the thoracodorsal system (TDSF) offer independently vascularized components that may address both posterior coverage and luminal restoration. We report what appears to be the first use of a chimeric TDSF for reconstruction following extended CPL.

A 68-year-old man with cT4aN1 squamous cell carcinoma of the right oro-hypopharyngeal wall underwent neoadjuvant chemotherapy followed by extended CPL, bilateral neck dissection and total thyroidectomy. Resection included the entire posterior rhino-oro-hypopharyngeal mucosa, creating an approximately 18-cm defect. A chimeric TDSF was harvested in supine position, combining a serratus anterior myofascial component for resurfacing the prevertebral fascia and a latissimus dorsi myocutaneous component to recreate the neopharyngeal circumference. Postoperative recovery was uneventful, with no fistula or stenosis. Oral feeding resumed on postoperative day 15, and the patient was discharged on day 20. Histopathology showed pT4aN3b disease with negative margins, enabling timely adjuvant chemoradiotherapy.

Chimeric TDSF reconstruction provided reliable posterior protection and functional pharyngeal restoration in a defect not amenable to standard techniques. This approach may represent a valuable option for selected complex CPL cases.