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Chimeric Lateral Arm Free Flap to Treat Pharyngocutaneous Fistula After Total Laryngectomy

Fodor, Lucian MD, PhD*; Chirila, Magdalena MD, PhD†,‡; Sobec, Raluca MD, PhD*; Sita, Laura MD*; Fodor, Marius MD, PhD§

doi: 10.1097/SCS.0000000000005615
Clinical Studies

Pharyngocutaneous fistula is a major complication after total laryngectomy, leading to a severe adverse impact for the patient and social activity. The reported incidence ranges from 9% to 25% in the last decade. In this paper, the authors present our experience using chimeric lateral arm free flap for reconstruction of the pharyngo-esophageal segment. Eight patients with pharyngocutaneous fistula were treated with this technique. The flap has 2 skin islands, each one supplied by a perforator coming from the main pedicle. One skin island is used as a patch for pharynx closure and the other is used for anterior soft tissue coverage. The follow-up period ranged from 8 months to 3 years. All flaps survived. There was 1 small fistula that was sutured. External skin wound dehiscence was present in 1 case and it was secondary closed by itself. All patients were able to eat by mouth and there were no signs of stricture. The authors preferred this type of flap because both defects are simultaneously closed and each skin paddle is supplied by a perforator coming from the main pedicle. It has a better color match than other free flaps. The skin island is thin and remains thin even after the patients gain weight.

*Emergency District Hospital, Plastic and Reconstructive Surgery Department

Emergency District Hospital

Iuliu Hatieganu University of Medicine and Pharmacy, Ear Nose and Throat Department

§Emergency District Hospital, Vascular Surgery Department, Cluj-Napoca, Romania.

Address correspondence and reprint requests to Magdalena Chirila MD, PhD, Emergency District Hospital, Ear Nose and Throat Department, 4-6 Clinicilor Str., 400006, Cluj-Napoca, Romania; E-mail:

Received 14 January, 2019

Accepted 1 April, 2019

The authors report no conflicts of interest.

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© 2019 by Mutaz B. Habal, MD.