Lateral Upper Arm Free Flap for Primary Reconstruction of Pharyngeal Defects in Ablative Oncological Surgery

Abstract

Free microvascular flaps are an established method for soft tissue reconstruction following ablative oncological surgery in the head and neck. Functional reconstructions of the hypopharynx and the pharyngoesophageal segment (PES) are of particular relevance, as they are highly demanding surgical procedures. So far, the radial forearm free flap (RFFF) and the free jejunal transfer have been the transplants predominantly used for this purpose. The lateral upper arm free flap (LUFF) presents an alternative method for the fasciocutaneous tissue transfer. We report on our experience with the LUFF in a 56-year-old male patient with a pT3pN0M0 squamous cell carcinoma of the hypopharynx. A pharyngocutaneous fistula developed 5 days after pharyngolaryngectomy with bilateral neck dissection. The fistula was localized between the pharyngeal constrictor muscle and the esophagus and was closed with an LUFF from the left arm. Excellent flap adaptation to the remaining pharyngeal mucosa was observed. Although the length of the vascular pedicle and the diameter of the vessels in the LUFF are smaller than those in the RFFF, neither pedicle length nor vessel diameter proved to be a problem. The LUFF can be recommended as a well-vascularized, relatively safe and reliable flap for reconstruction of tubular structures such as the hypopharynx and the PES after tumor ablation and as an alternative to the RFFF. The flexibility of the LUFF allows surgeons to reconstruct the anatomy of the lost soft tissues as adequately as possible.

Keywords

laryngeal neoplasm lateral upper arm free flap pharyngeal neoplasm reconstructive surgical procedure squamous cell carcinoma surgical flap

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References

Reinert

. The free revascularized lateral upper arm flap in maxillofacial reconstruction following ablative tumour surgery. J Craniomaxillofac Surg 2000; 28: 69–73.

Bootz

Keiner

. Rekonstruktionsverfahren zum Wiederaufbau des Hypopharynx nach Tumorexstirpation. HNO 1998; 46: 87–9.

Biller

Baek

Lawson

Krespi

Blaugrund

. Pectoralis major myocutaneous island flap in head and neck surgery: Analysis of complications in 42 cases. Arch Otolaryngol 1981; 107: 23–6.

Ossoff

Wurster

Berktold

Krespi

Sisson

. Complications after pectoralis major myocutaneous flap reconstruction of head and neck defects. Arch Otolaryngol 1983; 109: 812–4.

Schusterman

Kroll

Weber

Byers

Guillamondegui

Goepfert

. Intraoral soft tissue reconstruction after cancer ablation: A comparison of the pectoralis major flap and the free radial forearm flap. Am J Surg 1991; 162: 397–9.

Shah

Haribhakti

Loree

Sutaria

. Complications of the pectoralis major myocutaneous flap in head and neck reconstruction. Am J Surg 1990; 160: 352–5.

Wilson

Yiacoumettis

O'Neill

. Some observations on 112 pectoralis major myocutaneous flaps. Am J Surg 1984; 147: 273–9.

Schmelzeisen

Schliephake

. Interdisciplinary microvascular reconstruction of maxillary, midfacial and skull base defects. J Craniomaxillofac Surg 1998; 26: 1–10.

Soutar

McGregor

. The radial forearm flap in intraoral reconstruction: The experience of 60 consecutive cases. Plast Reconstr Surg 1986; 78: 1–8.

10.

Harii

Ebihara

Ono

Saito

Terui

Takato

. Pharyngoesophageal reconstruction using a fabricated forearm free flap. Plast Reconstr Surg 1985; 75: 463–76.

11.

Anthony

Neligan

Rotstein

Coleman

. Reconstruction of partial laryngopharyngectomy defects. Head Neck 1997; 19: 541–4.

12.

Song

. The upper arm free flap. Clin Plast Surg 1982; 9: 27–35.

13.

Sullivan

Carroll

Kuriloff

. Lateral arm free flap in head and neck reconstruction. Arch Otolaryngol Head Neck Surg 1992; 118: 1095–101.

14.

Katsaros

Schusterman

Beppu

Banis

Jr Acland

. The lateral upper arm flap: Anatomy and clinical applications. Ann Plast Surg 1984; 12: 489–500.

15.

Katsaros

Tan

Zoltie

Barton

Venugopalsrinivasan Venkataramakrishnan . Further experience with the lateral arm free flap. Plast Reconstr Surg 1991; 87: 902–10.

16.

Wenig

. The lateral arm free flap for head and neck reconstruction. Otolaryngol Head Neck Surg 1993; 109: 116–9.

17.

Civantos

Jr Burkey

Armstrong

. Lateral arm microvascular flap in head and neck reconstruction. Arch Otolaryngol Head Neck Surg 1997; 123: 830–6.

18.

Ross

Thomson

Restifo

Tarro

Sasaki

. The extended lateral arm free flap for head and neck reconstruction: The Yale experience. Laryngoscope 1996; 106: 14–8.

19.

Gellrich

Kwon

Lauer

. The lateral upper arm free flap for intraoral reconstruction. Int J Oral Maxillofac Surg 2000; 29: 104–11.

20.

Wax

Briant

Mahoney

. Lateral-arm free flap for reconstruction in the head and neck. J Otolaryngol 1996; 25: 140–4.

21.

Harpf

Papp

Ninkovic

Anderl

Hussl

. The lateral arm flap: Review of 72 cases and technical refinements. J Reconstr Microsurg 1998; 14: 39–48.

22.

Yousif

Warren

Matloub

Sanger

. The lateral arm fascial free flap: Its anatomy and use in reconstruction. Plast Reconstr Surg 1990; 86: 1138–47.

23.

Urken

Cheney

Sullivan

Biller

. Atlas of regional and free flaps for head and neck reconstruction. New York, NY: Raven Press, 1995.

24.

Aymard

. Nasal reconstruction with a note on nature's plastic surgery. Lancet 1917; 2: 888.

25.

Pickrell

Baker

Collins

. Reconstructive surgery of the chest wall. Surg Gynecol Obstet 1947; 84: 465.

26.

Roberts

Douglas

. Replacement of the cervical esophagus and hypopharynx by a revascularized free jejunal autograft: A report of a case successfully treated. N Engl J Med 1961; 264: 342.

27.

Timmons

Missotten

Poole

Davies

. Complications of radial forearm flap donor sites. Br J Plast Surg 1986; 39: 176–8.

28.

Bardsley

Soutar

Elliot

Batchelor

. Reducing morbidity in the radial forearm flap donor site. Plast Reconstr Surg 1990; 86: 287–94.

29.

Jones

O'Brien

. Acute ischaemia of the hand resulting from elevation of a radial forearm flap. Br J Plast Surg 1985; 38: 396–7.

30.

Little

Zylstra

West

May

. Circulatory patterns in the normal hand. Br J Surg 1973; 60: 652–5.

31.

Jacobson

Franssen

Fliss

Birt

Gilbert

. Free forearm flap in oral reconstruction. Functional outcome. Arch Otolaryngol Head Neck Surg 1995; 121: 959–64.

32.

Brandt

Khouri

. The lateral arm/proximal forearm flap. Plast Reconstr Surg 1993; 92: 1137–43.

33.

Kuek

Chuan

. The extended lateral arm flap: A new modification. J Reconstr Microsurg 1991; 7: 167–73.

34.

Lanzetta

Bernier

Chollet

St-Laurent

. The lateral forearm flap: An anatomic study. Plast Reconstr Surg 1997; 99: 460–4.

35.

Cormack

Lamberty

. Fasciocutaneous vessels in the upper arm: Application to the design of new fasciocutaneous flaps. Plast Reconstr Surg 1984; 74: 244–50.

36.

Gehrking

Remmert

Krappen

Sommer

. Klinischer Vergleich zwischen Radialis- und lateralem Oberarm-transplantat. Laryngorhinootologie 1997; 76: 162–8.

37.

Gehrking

Remmert

Majocco

. Der laterale Oberarmlappen: Topographisch-anatomische Studie fuer den klinischen Einsatz als gefaessgestieltes Transplantat. Laryngorhinootologie 1995; 74: 317–21.

38.

Moffett

Madison

Derr

Jr Acland

. An extended approach for the vascular pedicle of the lateral arm free flap. Plast Reconstr Surg 1992; 89: 259–67.

39.

Fogdestam

Tarnow

Kalaaji

. Extended free lateral arm flap with preservation of the posterior cutaneous nerve of the forearm. Scand J Plast Reconstr Surg Hand Surg 1996; 30: 49–55.

40.

Graham

Adkins

Scheker

. Complications and morbidity of the donor and recipient sites in 123 lateral arm flaps. J Hand Surg [Br] 1992; 17: 189–92.