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Determinants of Free Fasciocutaneous Flap Outcomes in Partial Hypopharyngeal Defects

Chen, Ching-En MD*†; Wu, Shang-Liang PhD; Liao, Wen-Chieh MD*†; Perng, Cherng-Kang MD, PhD*†; Ma, Hsu MD, PhD*†; Lin, Chih-Hsun MD, PhD*†

doi: 10.1097/SAP.0000000000001699

Background Most of the patients with hypopharyngeal cancer are still diagnosed with advanced stage, and total or partial pharyngectomy with free flap reconstruction is the mainstay of treatment. The aim of this study was to find out the possible risk factors related to surgical complications after free fasciocutaneous flap reconstruction for partial pharyngeal defect and its sequelae in the follow-up.

Patients and Methods We retrospectively reviewed the charts of patients with advanced hypopharyngeal cancer who received free fasciocutaneous flaps for partial pharyngeal defects reconstruction. From 2005 to 2015, 79 free fasciocutaneous flaps (59 free fasciocutaneous flaps and 20 anterolateral thigh flaps) were performed in our department. The risk factors for free flap outcome and complications were evaluated with multivariant linear regression model.

Results The mean age of patients was 60.8 years with male predominance. The mean follow-up duration was 39.6 months. Most of the cases (97.5%) were in stage III or IV. Patients with comorbidities showed significant correlation to flap failure (95% confidence interval [CI] = 0.038 to 0.264, P = 0.10). Anastomosis style (end-to-side vs end-to-end) was the only operation-related factors significantly related to flap failure rate (18.8% vs 3.2%, 95% CI = 0.031 to 0.32, P = 0.18). Flap size was significantly associated with fistula formation (95% CI = −0.005 to 0.000, P = 0.38).

Conclusions In our experience, patients with comorbidities and end-to-side anastomosis illustrate significantly higher flap failure rate in free fasciocutaneous flap reconstruction of partial hypopharyngeal defect. Reconstruction with smaller flap size had higher possibility of fistula formation.

From the *Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital;

School of Medicine, Department of Surgery, National Yang-Ming University, Taipei, Taiwan; and

School of Medicine, Griffith University, Gold Coast, Queensland, Australia.

Received September 17, 2018, and accepted for publication, after revision September 21, 2018.

Conflicts of interest and sources of funding: none declared.

Reprints: Chih-Hsun Lin, MD, PhD, Division of Plastic and Reconstructive Surgery, Taipei Veterans General Hospital, 19F, No 201, Sec 2, Shi-Pei St, Beitou Dist, Taipei 112, Taiwan (ROC). E-mail:

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