Reconstruction of phonatory function using a tubular free flap from upper-lateral upper arm after near-total laryngectomy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Liu , ZHENG Yitao ,  LI Wen

Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding?author：

LI Wen, Email: church.ent.wc@163.com

Keywords：

Laryngeal cancer; near-total laryngectomy; free flap; upper arm flap; phonatory reconstruction

DOI：

10.7507/1002-1892.202411048

Video：

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Objective To explore the feasibility of reconstruction of phonatory function by using a tubular free flap from upper-lateral upper arm to repair the laryngotracheal circumferential defect after near-total laryngectomy for laryngeal cancer. Methods A retrospective study was conducted on 7 patients who underwent near-total laryngectomy between June 2021 and October 2023, aged from 48 to 70 years (median, 59 years), 6 males and 1 female. The disease duration ranged from 1 to 11 months, with a median of 6 months. Pathological diagnosis of preoperative biopsy was squamous cell carcinoma. Tumor classification: glottic type in 5 cases, supraglottic type in 1 case, transglottic type in 1 case; TNM staging: T₄N₀M₀ in 6 cases, T₄N₂M₀ in 1 case; American Joint Committee on Cancer (AJCC) staging in 2017 was stage Ⅳ. Preoperative MRI angiography of upper arm was performed to investigate the blood supply in the upper and lateral regions of the upper arm. After near-total laryngectomy and bilateral neck lymph node dissection, the area of the laryngotracheal defect was measured. A free flap measuring 7.0 cm×5.0 cm to 8.0 cm×7.0 cm was harvested from the upper-lateral upper arm, rolled into a tube shape, and connected between the stump of the cervical trachea in the neck root and that of the epiglottis at the tongue base. Four patients received adjuvant radiochemotherapy, 1 patient received radiochemotherapy and targeted therapy, 2 patients adopted no further adjuvant treatment. Results All 7 patients were followed-up 1-2 years (mean, 1 year and 3 months). Four patients had primary wound healing, 2 patients had minor pharyngeal fistulas that healed after dressing change, 1 patient experienced pharyngeal fistula because of flap necrosis and the wound still healed without secondary surgery. All patients took food orally within 1 month after operation, and the tracheal cannula was retained. Six patients with survived flap gradually adapted to their new pronunciation mode and obtained satisfactory phonatory function from 15 days to 2 months after operation. Four patients had slight aspiration after operation. Till the end of the follow-up, all patients survived and no local recurrence or distant metastasis had been observed. The motor function of the upper arm was not affected, only partial sensory loss occurred in the area near the incision. The scar of the incision could be covered by the short sleeve so as to obtain a better aesthetic effect. Conclusion Using a tubular free flap from upper-lateral upper arm to repair the laryngotracheal circumferential defect after near-total laryngectomy for laryngeal cancer can achieve satisfactory phonatory restoration while preserve the motor function and aesthetics of the donor site.

Citation： YANG Liu, ZHENG Yitao, LI Wen. Reconstruction of phonatory function using a tubular free flap from upper-lateral upper arm after near-total laryngectomy. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(2): 209-214. doi: 10.7507/1002-1892.202411048 Copy

1.	Urken ML, Weinberg H, Buchbinder D, et al. Microvascular free flaps in head and neck reconstruction. Report of 200 cases and review of complications. Arch Otolaryngol Head Neck Surg, 1994, 120(6): 633-640.
2.	Song R, Song Y, Yu Y, et al. The upper arm free flap. Clin Plast Surg, 1982, 9(1): 27-35.
3.	Gellrich NC, Kwon TG, Lauer G, et al. The lateral upper arm free flap for intraoral reconstruction. Int J Oral Max Surg, 2000, 29(2): 104-11.
4.	袁冶, 陶震江, 吳煜農, 等. 上臂外側皮瓣在口腔癌術后缺損修復中的初步應用. 中華口腔醫學雜志, 2006, 41(10): 593-595.
5.	李贊, 喻建軍, 黃文孝, 等. 游離上臂外側皮瓣在頭頸腫瘤術后缺損修復的臨床應用. 組織工程與重建外科雜志, 2007, 3(2): 83-85.
6.	孫瑞梅, 王金德, 李群, 等. 改良游離上臂外側皮瓣應用解剖研究. 中華耳鼻咽喉頭頸外科雜志, 2013, 48(1): 37-41.
7.	Wang WM, Sun L, Yang SS, et al. Comparison between modified lateral arm free flap and traditional lateral arm free flap for the reconstruction of oral and maxillofacial Soft tissue defects. Front Oncol, 2022, 12: 877799. doi: 10.3389/fonc.2022.877799.
8.	Contrera KJ, Hassan AM, Shuck JW, et al. Outcomes for 160 consecutive lateral arm free flaps for head and neck reconstruction. Otolaryngol Head Neck Surg, 2024, 170(3): 747-757.
9.	李超, 蔡永聰, 王薇, 等. 游離上臂外側皮瓣在頭頸腫瘤術后修復重建中的角色定位. 中華耳鼻咽喉頭頸外科雜志, 2016, 51(2): 156-160.
10.	高建華, 羅力生, 陳林峰, 等. 上臂五種游離皮瓣的臨床應用及其評價. 中華整形燒傷外科雜志, 1989, 5(2): 89-90, 156.
11.	Yoshimatsu H, Karakawa R, Fuse Y, et al. The use of the deep brachial artery as the recipient artery for free perforator flap transfer: An anatomic study and clinical applications. Medicina (Kaunas), 2023, 59(6): 1087. doi: 10.3390/medicina59061087.
12.	楊柳, 李文, 鄭義濤, 等. 股前內側皮瓣修復晚期喉癌保留舌骨上部分會厭的近全喉切除后環周缺損. 中國修復重建外科雜志, 2024, 38(2): 133-139.
13.	Marques Faria JC, Rodrigues ML, Scopel GP, et al. The versatility of the free lateral arm flap in head and neck soft tissue reconstruction: clinical experience of 210 cases. J Plast Reconstr Aesthet Surg, 2008, 61(2): 172-179.
14.	Amin JD, Amin N, Hatten KM. The lateral arm free flap for head and neck reconstruction. Curr Opin Otolaryngol, 2020, 28(5): 365-369.
15.	de la Parra Marquez M, Fernandez-Riera R. Medial arm flap: An unexplored option for autologous breast reconstruction in the setting of morbid obesity. Ann Plast Surg, 2019, 82(2): 190-192.
16.	Meltem A, Metin G, Zeynep A, et al. The free deltoid flap: clinical applications to upper extremity, lower extremity, and maxillary defects. Microsurgery, 2007, 27(5): 420-424.
17.	Tweel M, Dow T, Greene B, et al. Anatomy, surgical techniques, and clinical outcomes for the medial arm flap: A systematic review. J Plast Reconstr Aesthet Surg, 2024, 92: 130-144.

1. Urken ML, Weinberg H, Buchbinder D, et al. Microvascular free flaps in head and neck reconstruction. Report of 200 cases and review of complications. Arch Otolaryngol Head Neck Surg, 1994, 120(6): 633-640.
2. Song R, Song Y, Yu Y, et al. The upper arm free flap. Clin Plast Surg, 1982, 9(1): 27-35.
3. Gellrich NC, Kwon TG, Lauer G, et al. The lateral upper arm free flap for intraoral reconstruction. Int J Oral Max Surg, 2000, 29(2): 104-11.
4. 袁冶, 陶震江, 吳煜農, 等. 上臂外側皮瓣在口腔癌術后缺損修復中的初步應用. 中華口腔醫學雜志, 2006, 41(10): 593-595.
5. 李贊, 喻建軍, 黃文孝, 等. 游離上臂外側皮瓣在頭頸腫瘤術后缺損修復的臨床應用. 組織工程與重建外科雜志, 2007, 3(2): 83-85.
6. 孫瑞梅, 王金德, 李群, 等. 改良游離上臂外側皮瓣應用解剖研究. 中華耳鼻咽喉頭頸外科雜志, 2013, 48(1): 37-41.
7. Wang WM, Sun L, Yang SS, et al. Comparison between modified lateral arm free flap and traditional lateral arm free flap for the reconstruction of oral and maxillofacial Soft tissue defects. Front Oncol, 2022, 12: 877799. doi: 10.3389/fonc.2022.877799.
8. Contrera KJ, Hassan AM, Shuck JW, et al. Outcomes for 160 consecutive lateral arm free flaps for head and neck reconstruction. Otolaryngol Head Neck Surg, 2024, 170(3): 747-757.
9. 李超, 蔡永聰, 王薇, 等. 游離上臂外側皮瓣在頭頸腫瘤術后修復重建中的角色定位. 中華耳鼻咽喉頭頸外科雜志, 2016, 51(2): 156-160.
10. 高建華, 羅力生, 陳林峰, 等. 上臂五種游離皮瓣的臨床應用及其評價. 中華整形燒傷外科雜志, 1989, 5(2): 89-90, 156.
11. Yoshimatsu H, Karakawa R, Fuse Y, et al. The use of the deep brachial artery as the recipient artery for free perforator flap transfer: An anatomic study and clinical applications. Medicina (Kaunas), 2023, 59(6): 1087. doi: 10.3390/medicina59061087.
12. 楊柳, 李文, 鄭義濤, 等. 股前內側皮瓣修復晚期喉癌保留舌骨上部分會厭的近全喉切除后環周缺損. 中國修復重建外科雜志, 2024, 38(2): 133-139.
13. Marques Faria JC, Rodrigues ML, Scopel GP, et al. The versatility of the free lateral arm flap in head and neck soft tissue reconstruction: clinical experience of 210 cases. J Plast Reconstr Aesthet Surg, 2008, 61(2): 172-179.
14. Amin JD, Amin N, Hatten KM. The lateral arm free flap for head and neck reconstruction. Curr Opin Otolaryngol, 2020, 28(5): 365-369.
15. de la Parra Marquez M, Fernandez-Riera R. Medial arm flap: An unexplored option for autologous breast reconstruction in the setting of morbid obesity. Ann Plast Surg, 2019, 82(2): 190-192.
16. Meltem A, Metin G, Zeynep A, et al. The free deltoid flap: clinical applications to upper extremity, lower extremity, and maxillary defects. Microsurgery, 2007, 27(5): 420-424.
17. Tweel M, Dow T, Greene B, et al. Anatomy, surgical techniques, and clinical outcomes for the medial arm flap: A systematic review. J Plast Reconstr Aesthet Surg, 2024, 92: 130-144.

Chinese Journal of Reparative and Reconstructive Surgery

Reconstruction of phonatory function using a tubular free flap from upper-lateral upper arm after near-total laryngectomy

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