Original Investigation |

Suprastomal Cutaneous Monitoring Paddle for Free Flap Reconstruction of Laryngopharyngectomy Defects

Peter C. Revenaugh, MD1; Heather H. Waters, MD1; Joseph Scharpf, MD1; P. Daniel Knott, MD2; Michael A. Fritz, MD1
[+] Author Affiliations
1Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
2Department of Otolaryngology, UCSF Medical Center, San Francisco, California
JAMA Facial Plast Surg. 2013;15(4):287-291. doi:10.1001/jamafacial.2013.845.
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Importance  Method of direct clinical monitoring of tissue perfusion in free tissue reconstruction of pharyngeal defects.

Objective  To describe a novel and effective method of incorporating a cutaneous skin paddle into laryngopharyngectomy reconstruction for direct clinical monitoring of anterolateral thigh free flaps.

Design  Retrospective review of pharyngoesophageal reconstruction for laryngopharyngectomy defects performed between August 1, 2008, and March 1, 2011, using the anterolateral thigh flap.

Setting  Tertiary care academic medical center.

Participants  Consecutive patients undergoing laryngopharyngectomy where free tissue transfer is indicated.

Interventions  Anterolateral thigh free flap reconstruction with suprastomal cutaneous monitoring paddle.

Main Outcome Measures  Postoperative complications, including flap failure, fistula, and stricture. Postoperative functional outcomes of swallowing and vocal capability were also measured.

Results  Twenty-one patients (mean age, 62.2 years; range, 39-81 years) underwent total laryngectomy with near-total or total pharyngectomy and immediate reconstruction with an anterolateral thigh free flap. The reconstructions included a cutaneous monitor paddle distal to the pharyngoesophageal anastomosis. Twenty patients were treated for squamous cell carcinoma and received either adjuvant or neoadjuvant radiation therapy. There were no partial or total flap losses. A late pharyngocutaneous fistula occurred at 6 weeks in 1 patient (5%), requiring exploration, and anastomotic stricture occurred in 4 patients (19%). All patients except 1 were able to swallow solid foods at a mean follow-up of 11.1 months. Nineteen patients (90%) underwent tracheoesophageal puncture and attained an intelligible voice. One patient (5%) had stomal stenosis requiring surgical management.

Conclusions and Relevance  The suprastomal cutaneous monitoring paddle enables direct monitoring of an otherwise buried reconstructive flap. This method allows direct clinical observation for microvascular compromise without a need for further procedures and without any increase in morbidity or compromise of speech and swallow functions.

Level of Evidence  4.

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Figure 1.
Anterolateral thigh Flap With Deepithelialized Portion (Arrow) And Monitoring Paddle (Arrowhead)
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Figure 2.
Insertion of the Suprastomal Cutaneous Monitoring Paddle
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Figure 3.
Postoperative Result With Skin Suprastomal Cutaneous Monitoring Paddle
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