Aesthetic Considerations of Simultaneous Reconstruction With Free Flap for Local Advanced Hypopharyngeal Combined With Cervical Esophageal Cancer

Background and objective: Patients with local advanced hypopharyngeal combined with esophageal cancer often require total laryngectomy and cervical esophagectomy, which result in big-sized upper aerodigestive tract defects and neck deformities. Although free flap is widely used to reconstruct aerodigestive defects, the aesthetic results especially that of neck contour have not brought to the forefront or discussed extensively. This article aims to report the preliminary aesthetic results of free flap reconstruction for local advanced hypopharyngeal cancer combined with cervical esophageal cancer defects, highlighting the thickness of subcutaneous fat of the flap.

Methods: A retrospective study of 21 patients with local advanced hypopharyngeal combined with cervical esophageal cancer from July 2010 to August 2022 was conducted. After completing total laryngectomy, bilateral neck dissection, and removal of the tumor with safe margin, a free thigh flap of subcutaneous fat greater than 1 cm in thickness was used to reconstruct the hypopharyngeal and cervical esophageal defects. In addition to general demographic, oncological, and reconstructive data, preoperative and postoperative neck circumferences were recorded and compared. A subjective questionnaire survey was conducted on patients' satisfaction with postoperative neck contour. The patients were followed up from 3 to 10 years, with an average of 3 years.

Results: There were 2 cases (2/21) of free flap loss because of flap necrosis and secondary repair with a pedicled pectoralis major flap. Nineteen flaps (19/21) survived. Three cases (3/21) developed a pharyngeal fistula and one case (1/21) experienced salivary fistula, all of the fistulae healed after drainage and dressing change. There was a relatively high satisfaction rate among patients (16/21) with the postoperative neck contour. A paired sample t test showed no statistically significant difference between the preoperative and postoperative values ( t = 2.002, P > 0.05). Patients with a thicker subcutaneous fat flap (≥1.5 cm) had a more symmetrical and fuller neck contour during long-term postoperative follow-up.

Conclusions: The application of a fat-rich subcutaneous free thigh flap to reconstruct the defect of local advanced hypopharyngeal combined with cervical esophageal cancer can achieve better neck aesthetic contour.