Clinical application of pedicled chimeric thoracoacromial artery perforator flap for circular hypopharyngeal reconstruction_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SONG Dajiang ¹ ,  LI Zan ¹ , ZHOU Xiao ¹ , ZHANG Yixin ² , PENG Xiaowei ¹ , ZHOU Bo ¹ , Lü Chunliu ¹ , WU Peng ¹ , TANG Yuanyuan ¹ , PENG Wen ¹ , MAO Huangxing ¹ , LIU Zeyang ¹

1. Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China;
2. Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011, P.R.China;

Corresponding?author：

LI Zan, Email: zzanli@163.com

Keywords：

Hypopharyngeal reconstruction; circular defect; thoracoacromial artery; perforator flap; chimeric flap; pectoralis major flap

DOI：

10.7507/1002-1892.201802017

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Objective To explore the effectiveness of pedicled chimeric thoracoacromial artery perforator (TAAP) flap as a reconstructive option for circular hypopharyngeal defects. Methods Between January 2013 and December 2014, the pedicled chimeric TAAP flap was used to repair oncologic circular hypopharyngeal defects in 8 patients, included 6 males and 2 females, with an average age of 57 years (range, 45-80 years). All patients were treated in other hospitals before and recurrence was noted. The duration between latest treatment and recurrence ranged from 3 to 28 months (mean, 16.5 months). According to Union for International Cancer Control (UICC) TNM staged, 3 cases were T₂N₁M₀, 2 cases were T₃N₁M₀, 1 case was T₃N₂M₀, 2 cases were T₄N₁M₀. After laryngectomy, the size of circular hypopharyngeal defect ranged from 9.0 cm×8.5 cm to 12.0 cm×10.5 cm. The size of TAAP flap ranged from 7.0 cm×4.0 cm to 9.5 cm×6.0 cm．The size of pectoralis major flap ranged from 9.0 cm×5.0 cm to 14.5 cm×6.0 cm．The donor sites were closed directly in all cases. Results Postoperatively all flaps survived smoothly, and all defects healed by first intention. No early complication was noted. The mean hospital stay period ranged from 12 to 22 days (mean, 14.5 days). All patients were followed up 12-45 months (mean, 18.7 months). Patients possessed good appearance of surgical sites. No recurrence, fistulas, stenosis/strictures, dehiscence, or swelling occurred. Only linear scars were left on the donor sites, and the pectoralis major muscle function was completely preserved in all patients. Conclusion Patients with high comorbidities may not be suitable candidates for free flap reconstruction, especially when the recipient vessels are affected from disease or radiotherapy. Pedicled chimeric TAAP flap is a good choice for the reconstruction of hypopharyngeal defects in such conditions．

Citation： SONG Dajiang, LI Zan, ZHOU Xiao, ZHANG Yixin, PENG Xiaowei, ZHOU Bo, Lü Chunliu, WU Peng, TANG Yuanyuan, PENG Wen, MAO Huangxing, LIU Zeyang. Clinical application of pedicled chimeric thoracoacromial artery perforator flap for circular hypopharyngeal reconstruction. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(11): 1441-1445. doi: 10.7507/1002-1892.201802017 Copy

1.	Burke MS, Kaplan SE, Kaplowitz LJ, et al. Pectoralis major myocutaneous flap for reconstruction of circumferential pharyngeal defects. Ann Plast Surg, 2013, 71(6): 649-651.
2.	Bootz F, Weber A, Oeken J, et al. Reconstruction of hypopharynx after pharyngolaryngectomy with U-shaped radial forearm flap. Laryngorhinootologie, 2002, 81(1): 17-21.
3.	Yu P, Lewin JS, Reece GP, et al. Comparison of clinical and functional outcomes and hospital costs following pharyngoesophageal reconstruction with the anterolateral thigh free flap versus the jejunal flap. Plast Reconstr Surg, 2006, 117(3): 968-974.
4.	Selber JC, Xue A, Liu J, et al. Pharyngoesophageal reconstruction outcomes following 349 cases. J Reconstr Microsurg, 2014, 30(9): 641-654.
5.	Yu P. One-stage reconstruction of complex pharyngoesophageal, tracheal, and anterior neck defects. Plast Reconstr Surg, 2005, 116(4): 949-956.
6.	王旭, 謝松林, 鄔嬌, 等. 胸肩峰動脈穿支皮瓣的應用解剖研究. 中國耳鼻咽喉顱底外科雜志, 2017, 23(2): 137-140.
7.	宋達疆, 李贊, 周曉, 等. 帶蒂胸肩峰動脈穿支皮瓣在放療和全喉切除術后咽瘺修復的臨床應用. 中國修復重建外科雜志, 2016, 30(10): 1249-1252.
8.	宋達疆, 李贊, 周曉, 等. 游離胸肩峰動脈穿支皮瓣修復舌癌術后缺損的療效觀察. 中國修復重建外科雜志, 2017, 31(2): 222-226.
9.	宋達疆, 章一新, 李贊, 等. 改良帶蒂胸肩峰動脈穿支皮瓣修復復雜咽瘺缺損: 九例經驗總結. 中華耳鼻咽喉頭頸外科雜志, 2016, 51(12): 918-922.
10.	宋達疆, 李贊, 周曉, 等. 胸肩峰動脈穿支皮瓣修復下咽癌切除術后缺損. 中華整形外科雜志, 2016, 32(4): 245-249.
11.	周曉, 周波, 李贊, 等. 中國腫瘤整形外科的歷史與現狀——腫瘤外科醫師有根治腫瘤的責任, 更有讓患者擁有健康美麗生活的義務. 中國耳鼻咽喉顱底外科雜志, 2016, 22(2): 85-90.
12.	周曉, 胡炳強, 羅以. 淺談腫瘤整形外科形成的必要性. 中國腫瘤, 2001, 10(12): 694-695.
13.	Reece GP, Schusterman MA, Miller MJ, et al. Morbidity and functional outcome of free jejunal transfer reconstruction for circumferential defects of the pharynx and cervical esophagus. Plast Reconstr Surg, 1995, 96(6): 1307-1316.
14.	Cordeiro PG, Shah K, Santamaria E, et al. Barium swallows after free jejunal transfer: should they be performed routinely? Plast Reconstr Surg, 1999, 103(4): 1167-1175.
15.	Ariyan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg, 1979, 63(1): 73-81.
16.	Saussez S, Cuno A, Urbain F, et al. Reconstruction of circumferential oro- and hypopharyngeal defects with U-shaped pectoralis major myocutaneous flap. Otolaryngol Head Neck Surg, 2006, 134(5): 823-829.
17.	Spriano G, Pellini R, Roselli R. Pectoralis major myocutaneous flap for hypopharyngeal reconstruction. Plast Reconstr Surg, 2002, 110(6): 1408-1416.
18.	Spriano G, Piantanida R, Pellini R. Hypopharyngeal reconstruction using pectoralis major myocutaneous flap and pre-vertebral fascia. Laryngoscope, 2001, 111(3): 544-547.
19.	張世民, 宋達疆. 穿支皮瓣的發現發展歷史與臨床啟示. 中國修復重建外科雜志, 2017, 31(7): 769-772.
20.	周曉, 宋達疆, 李贊, 等. 穿支皮瓣的發展及其在腫瘤整形外科學中的應用. 中國美容整形外科雜志, 2017, 28(2): 69-72.
21.	Patel RS, Goldstein DP, Brown D, et al. Circumferential pharyngeal reconstruction: history, critical analysis of techniques, and current therapeutic recommendations. Head Neck, 2010, 32(1): 109-120.
22.	Zhang YX, Li Z, Grassetti L, et al. A new option with the pedicle thoracoacromial artery perforator flap for hypopharyngeal reconstructions. Laryngoscope, 2015, 126(6): 1315-1320.
23.	Li Z, Cui J, Zhang YX, et al. Versatility of the thoracoacromial artery perforator flap in head and neck reconstruction. J Reconstr Microsurg, 2014, 30(7): 497-503.
24.	Zhang YX, Yongjie H, Messmer C, et al. Thoracoacromial artery perforator flap: anatomical basis and clinical applications. Plast Reconstr Surg, 2013, 131(5): 759e-770e.

1. Burke MS, Kaplan SE, Kaplowitz LJ, et al. Pectoralis major myocutaneous flap for reconstruction of circumferential pharyngeal defects. Ann Plast Surg, 2013, 71(6): 649-651.
2. Bootz F, Weber A, Oeken J, et al. Reconstruction of hypopharynx after pharyngolaryngectomy with U-shaped radial forearm flap. Laryngorhinootologie, 2002, 81(1): 17-21.
3. Yu P, Lewin JS, Reece GP, et al. Comparison of clinical and functional outcomes and hospital costs following pharyngoesophageal reconstruction with the anterolateral thigh free flap versus the jejunal flap. Plast Reconstr Surg, 2006, 117(3): 968-974.
4. Selber JC, Xue A, Liu J, et al. Pharyngoesophageal reconstruction outcomes following 349 cases. J Reconstr Microsurg, 2014, 30(9): 641-654.
5. Yu P. One-stage reconstruction of complex pharyngoesophageal, tracheal, and anterior neck defects. Plast Reconstr Surg, 2005, 116(4): 949-956.
6. 王旭, 謝松林, 鄔嬌, 等. 胸肩峰動脈穿支皮瓣的應用解剖研究. 中國耳鼻咽喉顱底外科雜志, 2017, 23(2): 137-140.
7. 宋達疆, 李贊, 周曉, 等. 帶蒂胸肩峰動脈穿支皮瓣在放療和全喉切除術后咽瘺修復的臨床應用. 中國修復重建外科雜志, 2016, 30(10): 1249-1252.
8. 宋達疆, 李贊, 周曉, 等. 游離胸肩峰動脈穿支皮瓣修復舌癌術后缺損的療效觀察. 中國修復重建外科雜志, 2017, 31(2): 222-226.
9. 宋達疆, 章一新, 李贊, 等. 改良帶蒂胸肩峰動脈穿支皮瓣修復復雜咽瘺缺損: 九例經驗總結. 中華耳鼻咽喉頭頸外科雜志, 2016, 51(12): 918-922.
10. 宋達疆, 李贊, 周曉, 等. 胸肩峰動脈穿支皮瓣修復下咽癌切除術后缺損. 中華整形外科雜志, 2016, 32(4): 245-249.
11. 周曉, 周波, 李贊, 等. 中國腫瘤整形外科的歷史與現狀——腫瘤外科醫師有根治腫瘤的責任, 更有讓患者擁有健康美麗生活的義務. 中國耳鼻咽喉顱底外科雜志, 2016, 22(2): 85-90.
12. 周曉, 胡炳強, 羅以. 淺談腫瘤整形外科形成的必要性. 中國腫瘤, 2001, 10(12): 694-695.
13. Reece GP, Schusterman MA, Miller MJ, et al. Morbidity and functional outcome of free jejunal transfer reconstruction for circumferential defects of the pharynx and cervical esophagus. Plast Reconstr Surg, 1995, 96(6): 1307-1316.
14. Cordeiro PG, Shah K, Santamaria E, et al. Barium swallows after free jejunal transfer: should they be performed routinely? Plast Reconstr Surg, 1999, 103(4): 1167-1175.
15. Ariyan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg, 1979, 63(1): 73-81.
16. Saussez S, Cuno A, Urbain F, et al. Reconstruction of circumferential oro- and hypopharyngeal defects with U-shaped pectoralis major myocutaneous flap. Otolaryngol Head Neck Surg, 2006, 134(5): 823-829.
17. Spriano G, Pellini R, Roselli R. Pectoralis major myocutaneous flap for hypopharyngeal reconstruction. Plast Reconstr Surg, 2002, 110(6): 1408-1416.
18. Spriano G, Piantanida R, Pellini R. Hypopharyngeal reconstruction using pectoralis major myocutaneous flap and pre-vertebral fascia. Laryngoscope, 2001, 111(3): 544-547.
19. 張世民, 宋達疆. 穿支皮瓣的發現發展歷史與臨床啟示. 中國修復重建外科雜志, 2017, 31(7): 769-772.
20. 周曉, 宋達疆, 李贊, 等. 穿支皮瓣的發展及其在腫瘤整形外科學中的應用. 中國美容整形外科雜志, 2017, 28(2): 69-72.
21. Patel RS, Goldstein DP, Brown D, et al. Circumferential pharyngeal reconstruction: history, critical analysis of techniques, and current therapeutic recommendations. Head Neck, 2010, 32(1): 109-120.
22. Zhang YX, Li Z, Grassetti L, et al. A new option with the pedicle thoracoacromial artery perforator flap for hypopharyngeal reconstructions. Laryngoscope, 2015, 126(6): 1315-1320.
23. Li Z, Cui J, Zhang YX, et al. Versatility of the thoracoacromial artery perforator flap in head and neck reconstruction. J Reconstr Microsurg, 2014, 30(7): 497-503.
24. Zhang YX, Yongjie H, Messmer C, et al. Thoracoacromial artery perforator flap: anatomical basis and clinical applications. Plast Reconstr Surg, 2013, 131(5): 759e-770e.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of pedicled chimeric thoracoacromial artery perforator flap for circular hypopharyngeal reconstruction

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