Inverted U-Shaped Anterolateral Thigh Flap and Prevertebral Fascia for Circumferential Pharyngoesophageal Reconstruction - A Case Report

Background: Circumferential pharyngeal defects after total laryngopharyngectomy are intuitively reconstructed with an intestinal or tubularized skin flap to restore the digestive tract continuity. However, stricture at the distal esophageal anastomosis remains an issue owing to the inherent circumferential contracture. Aim and Objectives: We present a case of circumferential pharyngoesophageal reconstruction using a nontubularized anterolateral thigh flap and the prevertebral fascia. Materials and Methods: A 47-year-old man diagnosed with hypopharyngeal cancer underwent total laryngopharyngectomy, which resulted in a circumferential pharyngeal defect. Pharyngoesophageal reconstruction was accomplished by using the prevertebral fascia as the posterior wall and an inverted U-shaped anterolateral thigh flap for the anterior and lateral walls. Results: Postoperative recovery was uneventful. Esophagography showed focal narrowing at the distal anastomosis without leakage or obstruction. After a 7-month follow-up, the patient was able to tolerate soft diet. Conclusion: Reconstruction of a circumferential pharyngeal defect by incorporating the prevertebral fascia to facilitate an inverted U-shaped anterolateral thigh flap reconstruction may minimize the occurrence of strictures. Additional, well-designed studies are required to confirm its effectiveness.

關鍵字

anterolateral thigh flap ； circumferential pharyngeal defect ； laryngopharyngectomy ； pharyngoesophageal reconstruction ； pre-vertebral fascia

並列摘要

背景：咽喉全切除術後的環狀咽食道缺損可直覺地用空腸或管狀皮瓣重建以恢復消化道的連續性。然而，基於固有的環形攣縮，遠端食道吻合處的狹窄仍然是一個問題。目的及目標：我們報告一個使用非管狀大腿前外側皮瓣和椎前筋膜進行環狀咽食道重建的案例。材料及方法：一名被診斷為下咽癌的47歲男性接受了全咽喉切除術，導致環狀咽食道缺損。咽食道重建採用椎前筋膜作為後壁，以倒U形大腿前外側皮瓣作為前壁和側壁。結果：術後恢復順利。食道攝影顯示遠端吻合處局部狹窄，無滲漏或阻塞。在7個月的追蹤，患者能夠經口食用軟性食物。結論：透過倒U形大腿前外側皮瓣合併椎前筋膜來重建環狀咽食道缺損，可能可以減少狹窄的發生，然而這需要精心設計的研究來確認其有效性。

並列關鍵字

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