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, 谢松林, 邬娇, 等. 胸肩峰动脉穿支皮瓣的应用解剖研究. 中国耳鼻咽喉颅底外科杂志, 2017, 23(2): 137-140.
7.	宋达疆, 李赞, 周晓, 等. 带蒂胸肩峰动脉穿支皮瓣在放疗和全喉切除术后咽瘘修复的临床应用. 中国修复重建外科杂志, 2016, 30(10): 1249-1252.
8.	宋达疆, 李赞, 周晓, 等. 游离胸肩峰动脉穿支皮瓣修复舌癌术后缺损的疗效观察. 中国修复重建外科杂志, 2017, 31(2): 222-226.
9.	宋达疆, 章一新, 李赞, 等. 改良带蒂胸肩峰动脉穿支皮瓣修复复杂咽瘘缺损: 九例经验总结. 中华耳鼻咽喉头颈外科杂志, 2016, 51(12): 918-922.
10.	宋达疆, 李赞, 周晓, 等. 胸肩峰动脉穿支皮瓣修复下咽癌切除术后缺损. 中华整形外科杂志, 2016, 32(4): 245-249.
11.	周晓, 周波, 李赞, 等. 中国肿瘤整形外科的历史与现状——肿瘤外科医师有根治肿瘤的责任, 更有让患者拥有健康美丽生活的义务. 中国耳鼻咽喉颅底外科杂志, 2016, 22(2): 85-90.
12.	周晓, 胡炳强, 罗以. 浅谈肿瘤整形外科形成的必要性. 中国肿瘤, 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.	张世民, 宋达疆. 穿支皮瓣的发现发展历史与临床启示. 中国修复重建外科杂志, 2017, 31(7): 769-772.
20.	周晓, 宋达疆, 李赞, 等. 穿支皮瓣的发展及其在肿瘤整形外科学中的应用. 中国美容整形外科杂志, 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, 谢松林, 邬娇, 等. 胸肩峰动脉穿支皮瓣的应用解剖研究. 中国耳鼻咽喉颅底外科杂志, 2017, 23(2): 137-140.
7. 宋达疆, 李赞, 周晓, 等. 带蒂胸肩峰动脉穿支皮瓣在放疗和全喉切除术后咽瘘修复的临床应用. 中国修复重建外科杂志, 2016, 30(10): 1249-1252.
8. 宋达疆, 李赞, 周晓, 等. 游离胸肩峰动脉穿支皮瓣修复舌癌术后缺损的疗效观察. 中国修复重建外科杂志, 2017, 31(2): 222-226.
9. 宋达疆, 章一新, 李赞, 等. 改良带蒂胸肩峰动脉穿支皮瓣修复复杂咽瘘缺损: 九例经验总结. 中华耳鼻咽喉头颈外科杂志, 2016, 51(12): 918-922.
10. 宋达疆, 李赞, 周晓, 等. 胸肩峰动脉穿支皮瓣修复下咽癌切除术后缺损. 中华整形外科杂志, 2016, 32(4): 245-249.
11. 周晓, 周波, 李赞, 等. 中国肿瘤整形外科的历史与现状——肿瘤外科医师有根治肿瘤的责任, 更有让患者拥有健康美丽生活的义务. 中国耳鼻咽喉颅底外科杂志, 2016, 22(2): 85-90.
12. 周晓, 胡炳强, 罗以. 浅谈肿瘤整形外科形成的必要性. 中国肿瘤, 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. 张世民, 宋达疆. 穿支皮瓣的发现发展历史与临床启示. 中国修复重建外科杂志, 2017, 31(7): 769-772.
20. 周晓, 宋达疆, 李赞, 等. 穿支皮瓣的发展及其在肿瘤整形外科学中的应用. 中国美容整形外科杂志, 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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