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Tube-in-a-Tube Anterolateral Thigh Flap for Reconstruction of a Complex Esophageal and Anterior Neck Defect

Komorowska-Timek, Ewa MD*; Lee, Gordon K. MD

doi: 10.1097/SAP.0b013e3182605400
Microsurgery

Restoration of a functional digestive track along with acceptable external neck coverage traditionally requires 2 separate flaps. We present a case of a 65-year-old man with a large cervical and esophageal defect treated successfully with a single anterolateral thigh (ALT) free flap. This patient had been treated with primary chemoradiation for laryngeal cancer, and subsequently, developed a severe esophageal stricture. He had undergone prior multiple attempts at reconstruction with a pectoralis major, radial forearm, and deltopectoral flaps, skin grafts, and gastric pull-up, which had all failed. We used an ALT free flap that was designed in a “tube-in-a-tube” fashion to simultaneously reconstruct the cervical esophagus while resurfacing the anterior neck. The patient successfully restarted a liquid diet on the 19th postoperative day. Tube-in-a-tube ALT flap design is a reliable and efficient way to concurrently restore esophageal continuity and provide anterior neck coverage in a single-stage procedure.

From the *Plastic Surgery of West Michigan and College of Human Medicine, Michigan State University, Grand Rapids, MI; and †Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Palo Alto, CA.

Received February 7, 2012, and accepted for publication, after revision, May 14, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: Ewa Komorowska-Timek, MD, Partners in Plastic Surgery of West Michigan, 4070 Lake Dr SE, Grand Rapids, MI 49546. E-mail: etimek@sbcglobal.net.

© 2014 by Lippincott Williams & Wilkins