Interdisciplinary defect reconstruction of the upper aerodigestive tract

Background Defects and dysfunctions of the upper aerodigestive tract after tumor surgery represent a major therapeutic challenge. An interdisciplinary defect reconstruction using the free anterolateral thigh (ALT) flap was evaluated in a study.

Material and methods In a retrospective study (2017-2023), we identified five patients with complex defects after laryngectomy and multiple revision surgeries. The operations were performed by an interdisciplinary team of ENT, plastic surgery and visceral/thoracic surgery. The outcome of these microsurgical reconstructions were recorded.

Results Defects included tracheoesophageal and pharyngocutaneous fistulas, neopharyngeal stenosis as well as their combinations. There was an average of six previous operations. Successful reconstruction with the ALT flap was achieved in 100% of cases. In three cases a split ALT flap was performed. ALT flow through flaps with an additional free jejunum interposition were used in two cases. Major complications occurred in 40% and minor complications in 20% of cases.

Conclusion Complex defects of the upper aerodigestive tract can be successfully reconstructed - even after multiple previous surgeries. The ALT flap is a very good option due to its versatility. From our point of view, a treatment approach in an interdisciplinary team with a critical consideration of patient- and disease-specific factors is an important prerequisite for therapeutic success.

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Artikel online veröffentlicht:
19. April 2024