Single-Stage, Double-Conduit Microvascular Pharyngotracheal Reconstruction

Dual island “paddle flaps” first described by Yu et al have demonstrated great utility in pharyngoesophageal and anterior neck reconstruction.[1] These fasciocutaneous flaps are tubed for the pharyngoesophageal reconstruction and a separate paddle is used for external skin reconstruction and Doppler monitoring. This technique has also found success in treating pharyngocutaneous fistulas.[2] Two case series have demonstrated good clinical and functional results with minimal morbidity using anterolateral thigh (ALT) dual island flaps for complex pharyngoesophageal, tracheal, and anterior neck defects.[1] [3] Ferguson and Yu described the use of the most distal skin of the ALT as an inconspicuous external skin-monitoring paddle for use in pharyngeal reconstruction, with very low incidence of fistula and/or stricture.[4] While Yu described repairing flat tracheal defects with such dual island paddle flaps,[1] no cases of circumferential tracheal reconstruction with such a dual island flap have been described.

Circumferential tracheoplasties with classic ALT and radial forearm free flaps (RFFF) have been previously described, and this technique has important utility for tracheal reconstruction after a variety of head and neck surgeries, including reconstruction of the tracheostoma after parastomal cancer recurrence.[5] Here, we present the first case of a single-stage, dual-conduit RFFF free flap for reconstruction following total pharyngectomy with cervical esophagectomy with subtotal, circumferential tracheal resection.

• References

• 1 Yu P. One-stage reconstruction of complex pharyngoesophageal, tracheal, and anterior neck defects. Plast Reconstr Surg 2005; 116 (4) 949-956
• 2 Abood A, Halvorson E, Pusic A, Mehrara B. A modified 'paddle-flap' for reconstruction of a large pharyngo-cutaneous fistula and anterior neck defect. Another tool in the anterolateral thigh's box. J Plast Reconstr Aesthet Surg 2009; 62 (6) e142-e144
• 3 Tan NC, Shih H-S, Chen C-C, Chen Y-C, Lin P-Y, Kuo Y-R. Distal skin paddle as a monitor for buried anterolateral thigh flap in pharyngoesophageal reconstruction. Oral Oncol 2012; 48 (3) 249-252
• 4 Ferguson Jr REH, Yu P. Techniques of monitoring buried fasciocutaneous free flaps. Plast Reconstr Surg 2009; 123 (2) 525-532
• 5 Caliceti U, Piccin O, Cavicchi O, Contedini F, Cipriani R. Anterolateral thigh free flap for tracheal reconstruction after parastomal recurrence. Head Neck 2009; 31 (8) 1107-1111
• 6 Suh JD, Sercarz JA, Abemayor E , et al. Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction. Arch Otolaryngol Head Neck Surg 2004; 130 (8) 962-966
• 7 Punthakee X, Zaghi S, Nabili V, Knott PD, Blackwell KE. Effects of salivary bypass tubes on fistula and stricture formation. JAMA Facial Plast Surg 2013; 15 (3) 219-225
• 8 Elliott MJ, De Coppi P, Speggiorin S , et al. Stem-cell-based, tissue engineered tracheal replacement in a child: a 2-year follow-up study. Lancet 2012; 380 (9846) 994-1000
• 9 Chan YW, Yu Chow VL, Lun Liu LH, Ignace Wei W. Manubrial resection and anterior mediastinal tracheostomy: friend or Foe?. Laryngoscope 2011; 121 (7) 1441-1445