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Annals of Plastic Surgery:
doi: 10.1097/SAP.0b013e3182605400
Microsurgery

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

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Abstract

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.

Copyright © 2013 by Lippincott Williams & Wilkins

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