Free posterior tibial flap reconstruction for hypopharyngeal squamous cell carcinoma

Abstract

Objectives: The aim of this article was to determine outcomes in patients with squamous cell carcinoma of the hypopharynx (SCCHP) in whom the free posterior tibial flap was used for primary reconstruction of hypopharynx defects after cancer resection.

Subjects and methods: Between August 2009 and February 2012, 10 patients with SCCHP underwent posterior tibial flap reconstruction for hypopharynx defects. The corresponding clinical data were retrospectively collected and analyzed.

Results: Despite the multistep and time-consuming procedure, the posterior tibial flap survival rate was 100%. Operation-induced complications did not occur in four patients. Six patients developed postoperative hypoproteinemia, four patients developed postoperative pulmonary infections, and four patients developed pharyngeal fistula. The pharyngeal and laryngeal functions of all patients were preserved.

Conclusion: Our experience demonstrates that the posterior tibial flap is a safe and reliable choice for the reconstruction of hypopharynx defects.

Figure 1

The harvesting process of the free posterior tibial flap. A: The posterior tibial flap was designed. B: The vessels of the posterior tibial were exposed. C: The posterior tibial flap was prepared. D: The posterior tibial flap was harvested.

Figure 2

The removal of SCCHP and the reconstruction for hypopharynx defects including the flap suture and microvascular anastomosis. SCCHP, Squamous cell carcinoma of the hypopharynx. A: the hypoharyngeal tumor was resected completely. B: The recipient vessels were prepared for microvascular anastomosis. C: The flap suture was performed. D: The microvascular anastomosis was performed.

Figure 3

The skin graft was conducted on the leg donor site.

Figure 4

Electronic laryngoscopy and computed tomography scan reveal the free posterior tibial flap and hypopharynx in a patient one year after reconstruction. The yellow arrow indicates the posterior tibial flap. A and B: The posterior tibial flap and hypopharynx were revealed by electronic laryngoscopy through two different angles. C: The posterior tibial flap and hypopharynx were revealed by computed tomography.