One-stage reconstruction of complex pharyngoesophageal, tracheal, and anterior neck defects

Background: Reconstruction of combined pharyngoesophageal, tracheal, and anterior neck defects is challenging and usually requires two flaps, which is sometimes accompanied by significant morbidity. Methods: Between March of 2002 and February of 2004, 18 consecutive patients with combined defects of the pharynx and cervical esophagus, trachea, and/or anterior neck skin underwent reconstruction with a single anterolateral thigh flap. The skin paddle was divided into two islands based on separate cutaneous perforators in 10 patients. In the remaining patients with only one cutaneous perforator, a portion of the vastus lateralis muscle was included to support skin grafting for anterior neck resurfacing. The clinical, functional, and aesthetic outcomes of these patients were reviewed. Results: All of the patients experienced complete healing of reconstruction of their anterior neck and tracheal defects with good aesthetic results and only minor complications. The average hospital stay was 7 days. Four patients had a small fistula, which healed spontaneously in three patients but did not heal because of a local recurrence in the fourth. Two patients had a stricture requiring endoscopic dilatation. All but one patient without recurrence tolerated an oral diet. Conclusion: Complex neck reconstruction can be accomplished with a single anterolateral thigh flap with good clinical and functional results, minimal morbidity, and quick recovery.