Clin Exp Otorhinolaryngol.  2021 Nov;14(4):407-413. 10.21053/ceo.2020.00234.

Externally Monitored Versus Conventional Buried Flaps in Laryngopharyngeal Reconstruction

• Ban MJ
• Na G
• Ko S
• Kim J
• Heo NH
• Choi EC
• Park JH
• Kim WS

• KMID: 2522432
• DOI: http://doi.org/10.21053/ceo.2020.00234

Abstract

Objectives
. To compare the surgical outcomes of externally monitored and conventional buried flaps with the goal of determining the usefulness of external monitoring of buried flaps.
Methods
. In this case-control study with propensity score matching, 30 patients were evenly divided into externally monitored buried flap and conventional buried flap groups. The total operative time for free flap reconstruction, the flap survival rate, the length of hospital stay, the initial time of a reliable visual assessment, complications, the final diet achieved, and the duration until diet initiation were compared between the groups.
Results
. The mean operative time for reconstruction was 115 minutes (interquartile range, 85–150 minutes) and 142 minutes (interquartile range, 95–180 minutes) in the externally monitored and conventional groups, respectively (P= 0.245). The median length of hospital stay was 24 days (interquartile range, 18–30 days) and 27 days (interquartile range, 20–41 days) in the externally monitored and conventional groups, respectively (P=0.298). The median duration until diet initiation was 15 days (interquartile range, 15–21 days) and 18 days (interquartile range, 15–34 days) in the externally monitored and conventional groups, respectively (P=0.466). The final diet, initial time of a reliable visual assessment, and complications were comparable between the groups, but the external skin paddle provided an excellent visual assessment immediately postoperatively in all cases.
Conclusion
. The outcomes were comparable between the groups, indicating that externalization of the cutaneous component of a buried flap may be a straightforward and useful technique for monitoring a buried anterolateral thigh free flap in laryngopharyngeal reconstructions. The salvage and false-positive rates of compromised flaps should be compared in large subject groups in future studies to prove that the use of an external skin paddle improves flap monitoring.

Keyword

Laryngectomy; Pharyngectomy; Reconstructive Surgical Procedures; Free Tissue Flaps; Perioperative Period; Buried Flaps; Externally Monitored Buried Flaps

Figure

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  Fig. 1. Preoperative design of an externally monitored buried flap on the anterolateral thigh.

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  Fig. 2. Harvested free anterolateral thigh flap after making a de-epithelialized bridge.

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  Fig. 3. Postoperative externalized viable skin paddle sutured on the upper side of the tracheostoma after total laryngectomy with partial pharyngectomy.

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  Fig. 4. Healed externally monitored buried flap. (A) Upper side of the tracheostoma after total laryngectomy with partial pharyngectomy. (B) Gap between the transverse skin incision after partial laryngectomy without pharyngectomy.

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  Fig. 5. Positive pin-prick test of the externally monitored buried flap on the third postoperative day.

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