Single free anterolateral thigh flap for simultaneous reconstruction of composite hypopharyngeal and external neck skin defect after head and neck cancer ablation.

Single flap for complex hypopharyngoesophageal and anterior neck skin defect reconstruction is still a challenge for reconstructive surgeons. Herein, we present five patients, with advanced hypopharyngeal cancer and anterior neck skin invasion, which received a single anterolateral thigh (ALT) fasciocutaneous flap for composite inner pharyngeal and outer skin defect reconstruction after wide composite resection. Two ALT flaps were divided into two distinct paddles supplied by two or more separate perforators, one part for reconstructing the inner pharyngeal defect and another for neck skin coverage. Three ALT flaps only supplied by one sizable perforator could not be divided and de-epithelization of mid-part had to be done to reconstruct both defects with the single flap. The results revealed survival of all flaps. There were no flap loss, fistulas, or bleeding complications. All patients recovered uneventfully and could eat a soft diet to regular diet postoperatively. In conclusion, one-staged reconstruction of complex pharyngoesophageal and external skin defects after extensive oncological resection is feasible using a single ALT fasciocutaneous free flap.

Stair-step flap for secondary lower lip revision after lip and cheek composite defects reconstruction.

BACKGROUND: Free flap reconstruction is a common procedure for through-and-through lip and cheek complex defects after cancer ablation. However, oral incompetence with unacceptable bulky flap appearance invariably occurs and needs a secondary revisionary procedure. The purpose of this article was to present our method to improve the oral competence and cosmetic appearance by the stair-step technique of flap revision. METHODS: Fourteen patients who had undergone flap folding reconstruction of the lip and cheek complex defect resulting in oral incontinence were involved in this study. Thirteen patients had been treated with an anterolateral thigh flap and 1 patient had been treated with a fibular osteocutaneous flap. This revisionary stair-step technique was combined with simultaneous liposuction of the bulky flap in all cases. RESULTS: Adequate oral continence and good contour was achieved in 12 patients. The remaining 2 patients still had mild drooling, which was managed successfully with a second stair-step flap. CONCLUSION: This technique is a valuable option for revision of lower lip deformity.