Reconstrucción de cabeza y cuello mediante colgajos libres microvascularizados. Indicaciones, aspectos técnicos y resultados

Closing of large pharyngostomes with free flaps and proposal of a new classification

PURPOSE

Large pharyngocutaneous fistulas or pharyngostomes are difficult complications to solve, which generate high morbidity and mortality, a poor quality of life and an increase in health costs. Its management must be comprehensive according to general, local and regional factors. We review our experience in treating these pharyngostomes with free flaps.

METHODS

Retrospective study analyzing the results of the reconstruction of 50 patients using free flaps during the period 1991-2019. We exclude patients who required free-flap reconstruction due to primary tumor or those who resolved in other ways. The different types of reconstruction were classified into three types.

RESULTS

The 86% (43) were men, and the mean age was 57 years (25-76). In 48% (24/50) the flaps performed were anterolateral thigh (ALT), in 24% (12/50) forearm, in 22% (11/50) parascapular, in 4% (2/50) jejunum and in 2% (1/50) ulnar. A salivary by-pass was placed in 74% (37/50) of the cases. Four cases (8%) presented flap necrosis and two patients died due to treatment. In 86% (43/50) there was some type of complication and 34% (17/50) required surgical revision. 94% (45/48) were able to reintroduce oral feeding.

CONCLUSION

According to our experience, we proposed a regardless size classification: type 1 when only a mucous closure (pharynx) are required (6%), type 2 exclusively skin for cutaneous coverage (10%) and mixed type 3 (mucous and skin) (84%). The treatment of large pharyngostomes with free flaps, despite its complexity, is in our experience the best option for its management.

Versatility of the radial forearm free flap in head and neck reconstruction. A study of 58 cases

INTRODUCTION

The radial forearm free flap (RFFF) is a widely used tool in head and neck reconstructive surgery. It stands out as a relatively simple flap to achieve; it is versatile and has features that enable the reconstruction of complex head and neck defects. The aim of the study was to present our results using the RFFF in the reconstruction of seated defects in the head and neck area.

MATERIAL AND METHODS

A retrospective, observational and analytical study that included 58 cases of RFFF interventions, performed between January 2002 and July 2019. The data studied were the age and sex of the patients, location of the tumour, histological type, previous radiation therapy, number of venous anastomoses performed in the surgery and body temperature in the immediate postoperative period, at 24 and 48hours following surgery.

RESULTS

The percentage of viable RFFF was 82.8%. None of the variables analysed appear to be a risk factor for flap failure. The most frequent cause of flap failure was venous thrombosis.

CONCLUSIONS

Microvascularised flaps play an important role in reconstructive surgery, being the RFFF one of the most interesting for head and neck reconstruction. It is a very versatile tool that allows the reconstruction of many of the sites where the head and neck surgeon operates.