Circumfertial pharyngeal reconstruction with an ALT Flap in Salvage cases - A case series

Complete hypopharyngoesophageal (HPE) stenosis is rare and a challenging condition to treat. When endoscopic therapy fails, total laryngectomy with or without pharyngeal reconstruction is usually performed. We present a retrospective case series involving 3 patients with complete HPE stenosis who failed endoscopic repair and were gastrostomy dependent. All were managed successfully with the sternocleidomastoid myocutaneous (SCM) flap. A temporary fistula occurred in 1 patient. Hospitalization ranged from 5 to 15 days, patients resumed oral intake from 21 to 82 days postoperatively, and their gastrostomy tubes were removed from 28 to 165 days postoperatively. We suggest that the SCM flap is a laryngeal preservation option for reconstruction of complete HPE stenosis when endoscopic techniques fail. This flap allows HPE repair and reconstruction within the same surgical field, imposes no significant donor site morbidity, and affords good functional and cosmetic outcomes.

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Versatility of the Free ALT Flap for Upper and Lower Limbs Coverage Defects Reconstruction. A Consecutive Case Series

International Journal of Orthoplastic Surgery ◽

10.29337/ijops.17 ◽

2018 ◽

Vol 1 (2) ◽

pp. 41-46

Author(s):

Jorge Boretto ◽

Javier Bennice ◽

Alessandro Thione ◽

Gerardo Gallucci ◽

Pablo De Carli

Keyword(s):

Case Series ◽

Lower Limbs ◽

Consecutive Case ◽

Alt Flap

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CO2 Laser Division of Neo-Vallecula Improves Dysphagia in the Postlaryngectomy Patient: A Case Series and Review of the Literature

Case Reports in Otolaryngology ◽

10.1155/2020/4015201 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Mohamad Z. Saltagi ◽

Chelsey A. Wallace ◽

Avinash V. Mantravadi ◽

Michael W. Sim

Keyword(s):

Co2 Laser ◽

Free Flap ◽

Total Laryngectomy ◽

Harmonic Scalpel ◽

Case Series ◽

Review Of The Literature ◽

Closure Technique ◽

Endoscopic Procedures ◽

Diagnosis And Management ◽

Pharyngeal Reconstruction

Objectives. To review the literature on neo-vallecula diagnosis and management and to report our findings regarding 3 patients who developed neo-vallecula in the context of free-flap pharyngeal reconstruction following total laryngectomy. Methods. This case series reports three patients who developed a neo-vallecula following a laryngectomy and free-flap pharyngeal reconstruction. All three patients were treated with a CO2 laser endoscopic procedure. Results. Neo-vallecula formation is thought to be related to tension on the neopharyngeal closure or closure technique following total laryngectomy. Diagnosis may be obtained with swallow studies, videofluoroscopy, or endoscopy. Treatment has included external excision and endoscopic procedures such as stapling, harmonic scalpel excision, and laser removal. We utilized an endoscopic approach entailing the use of a CO2 laser to divide the neo-vallecula, and all our patients reported improvement in their dysphagia. Conclusions. Treatment of an anterior neo-vallecula endoscopically using a CO2 laser is an effective way to treat dysphagia in patients following total laryngectomy with free-flap pharyngeal reconstruction.

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Pharyngeal reconstruction with a modified free alt flap with parastomal fascial wings

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2020.11.029 ◽

2020 ◽

Author(s):

B El-Khayat ◽

I Anderson ◽

OA Ahmed ◽

M Ragbir ◽

DB Saleh ◽

...

Keyword(s):

Pharyngeal Reconstruction ◽

Alt Flap

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Keystone Design Perforator Island Flap for Closure of the Anterolateral Thigh Flap Donor Site: a Case Series and Our Experience

10.21203/rs.3.rs-483998/v1 ◽

2021 ◽

Author(s):

Feiyu Cai ◽

Yanshi Liu ◽

Kai Liu ◽

Jiasharete Jielile ◽

Aihemaitijiang Yusufu

Keyword(s):

Donor Site ◽

Case Series ◽

Island Flap ◽

Anterolateral Thigh Flap ◽

High Survival ◽

Anterolateral Thigh ◽

Mean Size ◽

The Mean ◽

Alt Flap

Abstract Purpose: With the development of microsurgical techniques, the anterolateral thigh (ALT) flap has been widely used in reconstruction of various soft-tissue defects. However, there were few studies focusing on the closure of the ALT flap donor site, especially when the width of the harvested ALT flap was more than 6 cm. The purpose of this study was to share our experience of using Keystone Design Perforator Island Flap (KDPIF) to repair the ALT flap donor site where can’t be closed without a skin graft.Method: A retrospective study was used to analyze 12 patients who underwent the reconstruction of the ALT flap donor site using KDPIF from February 2018 to December 2020. Demographics, flap characteristics, surgical technique, postoperative complications, Vancouver Scar Scale (VSS) score, and Scar Cosmesis Assessment and Rating (SCAR) score were statistically analyzed.Results: 12 patients (10 males, 2 females) with the mean age 47.5 years (range, 27-66 years) were included in this study. All ALT flap donor sites were closed by the KDPIF. The mean size of the harvested ALT flap (the donor site size) was 8.1 cm × 14.4 cm (range from 8.0 cm × 11.0 cm to 9.0 cm × 21.0 cm), and the mean size of keystone flap was 9.1 cm × 16.4 cm (range from 8.0 cm × 13.0 cm to 12.0 cm × 19.0 cm). At the mean follow-up of 8.3 months (range, 6-12 months), two patients suffered from the skin infection around the flap, which was controlled under the treatment of wound dressing change and oral antibiotics. Wound dehiscence, osteofascial compartment syndrome (OCS), venous return disorder, and skin necrosis were not presented in any patients. All patients were evaluated at the final follow-up with ASS core (mean, 6.7; range, 5-8) and SCAR core (mean, 7.3; range, 6-9).Conclusion: This study demonstrated that the KDPIF that can be used to close the ALT flap donor site primarily is an effective and alternative treatment for patients with a the width of the donor site more than 6 cm including the advantages of high survival rate, low morbidity, good aesthetics, and simple operation.

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Use of acellular dermal matrices in laryngotracheal and pharyngeal reconstruction: systematic review

The Journal of Laryngology & Otology ◽

10.1017/s0022215117001049 ◽

2017 ◽

Vol 131 (7) ◽

pp. 585-592 ◽

Cited By ~ 5

Author(s):

A Hui ◽

P Hong ◽

M Bezuhly

Keyword(s):

Head And Neck ◽

Case Series ◽

Acellular Dermal Matrix ◽

Head And Neck Reconstruction ◽

Complication Rates ◽

Dermal Matrix ◽

Neck Reconstruction ◽

Dermal Matrices ◽

Acellular Dermal ◽

Pharyngeal Reconstruction

AbstractBackground:Acellular dermal matrices are increasingly used in laryngotracheal and pharyngeal reconstruction, but specific indications and the type of acellular dermal matrix used vary. The authors systematically reviewed outcomes relating to acellular dermal matrix use in head and neck reconstruction.Methods:Electronic databases were searched through 1 May 2016 for literature on acellular dermal matrix use in laryngotracheal and pharyngeal reconstruction. Studies were appraised for surgical indications, outcomes and study design.Results:Eleven publications with 170 cases were included. Eight articles reported on acellular dermal matrix use in oncological reconstruction. Most studies were case series; no high-level evidence studies were identified. Graft extrusion was more common in non-oncological applications. In general, post-oncological reconstruction with an acellular dermal matrix demonstrated complication rates similar to those reported without an acellular dermal matrix.Conclusion:Evidence in support of acellular dermal matrix use in head and neck reconstruction is generally poor. Prospective comparative studies are required to define the indications, safety and effectiveness of acellular dermal matrices in laryngotracheal and pharyngeal reconstruction.

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Microsurgical Reconstruction of the Nose: The Aesthetic Approach to Total Defects

Journal of Reconstructive Microsurgery ◽

10.1055/s-0040-1719047 ◽

2020 ◽

Author(s):

Valentina Pinto ◽

Elisa Antoniazzi ◽

Federico Contedini ◽

Marco Pignatti ◽

Angelo Pizzigallo ◽

...

Keyword(s):

Surgical Techniques ◽

Case Series ◽

Current Approach ◽

Nasal Reconstruction ◽

Forehead Flap ◽

Radial Forearm ◽

The Aesthetic ◽

Skin Coverage ◽

Alt Flap ◽

Nasal Defects

Abstract Background Reconstruction of complex defects involving nose and close facial units represents an aesthetic and functional challenge. Restoring satisfactory nasal shape, combining aesthetic, nasal function and patent airways is mandatory. In this paper, we describe our approach to total nose defects and we report our 20-year experience in microvascular nose reconstruction.Clinical cases are shown to illustrate different surgical techniques and the evolution of our approach. Methods Nasal reconstruction procedures were performed on 21 patients between 2000 and 2020 using the radial forearm flap (RFF) or anterolateral thigh (ALT) flap. Reported reconstructions included total/subtotal nasal defects, caused by cancer resections. The key point of our approach is the expanded forehead flap for skin coverage. Reconstruction is completed by cartilage grafts to restore nasal framework and to shape nasal tip. Ancillary procedures were needed in some cases to optimize aesthetic outcomes. Results Twenty-one patients completed the multistage nasal reconstruction. The RFF flap was used in 56% of the cases (n = 11), while the ALT flap was used in 44% (n = 10) of our case series. No difference has been detected in the number of reconstructive stages required to achieve the final result comparing RFF and ALT reconstruction (3.3 vs. 3.1 reconstructive steps). Ancillary procedures were performed in 7 patients. Conclusion Microvascular tissue transfer plays a key role in full-thickness nasal defects restoration. Comparing the two groups, both the RFF and ALT are effective and reliable options in lining reconstruction, although with different indications. Expanded forehead flap, combined to free cartilage graft, is our gold standard to provide external skin coverage to rebuild the nasal framework. According to our current approach, accurate preoperative planning, supported by modern technologic tools, multistage reconstruction, and ancillary procedures are useful to accomplish satisfactory functional and aesthetic outcomes.

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