Skip to main content

Advertisement

SpringerLink
Log in

Peroneal Flap in Hypopharyngeal Reconstruction

  • Reconstructive Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Hypopharyngeal reconstruction is a complex and challenging task because the goal of the reconstruction is not only defect filling but also restoring functions such as swallowing and speech. In this article, we present a novel approach of using peroneal flaps in hypopharyngeal reconstructions.

Methods

Between 1997 and 2011, 14 peroneal flaps were used to reconstruct the hypopharynx of 13 patients. We retrospectively reviewed all the medical records from those surgeries, searching for either short-term postoperative complications or long-term follow-up morbidity, and researched relevant articles for comparisons with other types of flaps.

Results

Of the 14 peroneal flaps, five were applied in tubed form for a circumferential defect. The remaining nine peroneal flaps were applied in the form of a patch for a noncircumferential defect. None of the 14 flaps underwent flap loss. The rates of stenosis and fistula formation were 7.1 and 14.3 %, respectively. The average postoperative hospital stay was 20.2 days. Of 13 patients, nine were able to resume at least a soft diet after the reconstruction. Only one patient remained on nasogastric feeding through the 6-month follow-up period. None of the patients experienced significant complications.

Conclusions

A peroneal flap reconstruction has comparable postoperative complications and donor site morbidity and should be considered as a viable option for hypopharyngeal reconstruction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Carvalho AL, Nishimoto IN, Califano JA, Kowalski LP. Trends in incidence and prognosis for head and neck cancer in the United States: a site-specific analysis of the SEER database. Int J Cancer. 2005;114:806–16.

    Article  PubMed  CAS  Google Scholar 

  2. Brockstein BE. Treatment of locoregionally advanced (stage III and IV) head and neck cancer: the larynx and hypopharynx. In: Brizel DM, ed. UpToDate. Waltham, MA: UpToDate; 2012.

    Google Scholar 

  3. Hui Y, Wei WI, Yuen PW, Lam LK, Ho WK. Primary closure of pharyngeal remnant after total laryngectomy and partial pharyngectomy: how much residual mucosa is sufficient? Laryngoscope. 1996;106:490–4.

    Article  PubMed  CAS  Google Scholar 

  4. Richmon JD, Brumund KT. Reconstruction of the hypopharynx: current trends. Curr Opin Otolaryngol Head Neck Surg. 2007;15:208–12.

    Article  PubMed  Google Scholar 

  5. Yoshimura M, Imura S, Shimamura K, Yamauchi S, Nomura S. Peroneal flap for reconstruction in the extremity: preliminary report. Plast Reconstr Surg. 1984;74:402–9.

    Article  PubMed  CAS  Google Scholar 

  6. Noda I, Saito H, Fujieda S, Tsuda G, Honda N, Manabe Y, et al. Reconstruction with peroneal free flap after ablation of head and neck cancer. Nihon Jibiinkoka Gakkai Kaiho. 1991;94:1865–71.

    Article  PubMed  CAS  Google Scholar 

  7. Wolff KD. The supramalleolar flap based on septocutaneous perforators from the peroneal vessels for intraoral soft tissue replacement. Br J Plast Surg. 1993;46:151–5.

    Article  PubMed  CAS  Google Scholar 

  8. Wolff KD, Stellmach R. The osteoseptocutaneous or purely septocutaneous peroneal flap with a supramalleolar skin paddle. Int J Oral Maxillofac Surg. 1995;24:38–43.

    Article  PubMed  CAS  Google Scholar 

  9. Ikeda K, Yokoyama M, Okada K, Tomita K, Nagayama I. Oral reconstruction using the peroneal flap. Br J Plast Surg. 1997;50:595–9.

    Article  PubMed  CAS  Google Scholar 

  10. Yang KC, Leung JK, Chen JS. Double-paddle peroneal tissue transfer for oromandibular reconstruction. Plast Reconstr Surg. 2000;106:47–55.

    Article  PubMed  CAS  Google Scholar 

  11. Piazza C, Taglietti V, Nicolai P. Reconstructive options after total laryngectomy with subtotal or circumferential hypopharyngectomy and cervical esophagectomy. Curr Opin Otolaryngol Head Neck Surg. 2012;20:77–88.

    Article  PubMed  Google Scholar 

  12. Seidenberg B, Rosenak SS, Hurwitt ES, Som ML. Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment. Ann Surg. 1959;149:162–71.

    Article  PubMed  CAS  Google Scholar 

  13. McGregor IA. The temporal flap in intra-oral cancer: its use in repairing the post-excisional defect. Br J Plast Surg. 1963;16:318–35.

    Article  PubMed  CAS  Google Scholar 

  14. Bakamjian VY. A two-stage method for pharyngoesophageal reconstruction with a primary pectoral skin flap. Plast Reconstr Surg. 1965;36:173–84.

    Article  PubMed  CAS  Google Scholar 

  15. Daniel RK, Taylor GI. Distant transfer of an island flap by microvascular anastomoses. A clinical technique. Plast Reconstr Surg. 1973;52:111–7.

    Article  PubMed  CAS  Google Scholar 

  16. Harii K, Ebihara S, Ono I, Saito H, Terui S, Takato T. Pharyngoesophageal reconstruction using a fabricated forearm free flap. Plast Reconstr Surg. 1985;75:463–76.

    Article  PubMed  CAS  Google Scholar 

  17. Koshima I, Fukuda H, Yamamoto H, Moriguchi T, Soeda S, Ohta S. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg. 1993;92:421–8; discussion 429–30.

    Article  PubMed  CAS  Google Scholar 

  18. Endo T, Nakayama Y. Pharyngoesophageal reconstruction: a clinical comparison between free tensor fasciae latae and radial forearm flaps. J Reconstr Microsurg. 1997;13:93–7.

    Article  PubMed  CAS  Google Scholar 

  19. Li KK, Salibian AH, Allison GR, Krugman ME, Armstrong W, Wong B, et al. Pharyngoesophageal reconstruction with the ulnar forearm flap. Arch Otolaryngol Head Neck Surg. 1998;124:1146–51.

    Article  PubMed  CAS  Google Scholar 

  20. Schipper J, Ridder GJ, Boedeker CC, Fradis M, Golz A, Gellrich NC. Lateral upper arm free flap for primary reconstruction of pharyngeal defects in ablative oncological surgery. Report of six consecutive cases. Ann Otol Rhinol Laryngol. 2003;112:611–6.

    PubMed  Google Scholar 

  21. Perez-Smith D, Wagels M, Theile DR. Jejunal free flap reconstruction of the pharyngolaryngectomy defect: 368 consecutive cases. J Plast Reconstr Aesthet Surg. 2013;66:9–15.

    Article  PubMed  Google Scholar 

  22. Bernstein EF, Salomon GD, Harisiadis L, Talbot T, Harrington F, Russo A, et al. Collagen gene expression and wound strength in normal and radiation-impaired wounds. A model of radiation-impaired wound healing. J Dermatol Surg Oncol. 1993;19:564–70.

    Article  PubMed  CAS  Google Scholar 

  23. Hopewell JW. Early and late changes in the functional vascularity of the hamster cheek pouch after local X-irradiation. Radiat Res. 1975;63:157–64.

    Article  PubMed  CAS  Google Scholar 

  24. Anthony JP, Singer MI, Mathes SJ. Pharyngoesophageal reconstruction using the tubed free radial forearm flap. Clin Plast Surg. 1994;21:137–47.

    PubMed  CAS  Google Scholar 

  25. Chen YL, Zheng BG, Zhu JM, Zheng BX, Gu YD, Wu MM et al. Microsurgical anatomy of the lateral skin flap of the leg. Ann Plast Surg. 1985;15:313–8.

    Article  PubMed  CAS  Google Scholar 

  26. Murray DJ, Novak CB, Neligan PC. Fasciocutaneous free flaps in pharyngolaryngo-oesophageal reconstruction: a critical review of the literature. J Plast Reconstr Aesthet Surg. 2008;61:1148–56.

    Article  PubMed  Google Scholar 

  27. Liu WW, Li H, Guo ZM, Zhang Q, Yang AK, Liu XK, et al. Reconstruction of soft-tissue defects of the head and neck: radial forearm flap or anterolateral thigh flap? Eur Arch Otorhinolaryngol. 2011;268:1809–12.

    Article  PubMed  Google Scholar 

  28. Disa JJ, Pusic AL, Hidalgo DA, Cordeiro PG. Microvascular reconstruction of the hypopharynx: defect classification, treatment algorithm, and functional outcome based on 165 consecutive cases. Plast Reconstr Surg. 2003;111:652–60; discussion 661–3.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Ying-Sheng Lin MD, MPH, Wen-Chung Liu MD, Lee-Wei Chen MD, PhD & Kuo-Chung Yang MD

  2. College of Medicine, National Yang-Ming University, Taipei, Taiwan

    Lee-Wei Chen MD, PhD & Kuo-Chung Yang MD

Authors
  1. Ying-Sheng Lin MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wen-Chung Liu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lee-Wei Chen MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kuo-Chung Yang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kuo-Chung Yang MD.

Additional information

Ying-Sheng Lin and Wen-Chung Liu contributed equally to this work.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Fig. 1

a The design of peroneal flap. The flap is roughly centered at the junction of the middle and lower thirds of the fibula and two-thirds of the flap is put behind the posterior border of the fibula. b The typical peroneal flap before the transection of its pedicle. Note the thinness of the flap (DOC 745 kb)

Supplementary Fig. 2

a A 51-year-old man presented with dysphagia and a skin defect over the neck. Due to hypopharyngeal cancer, he had undergone a total laryngectomy and reconstruction with peroneal flap 8 months ago. b A 7 cm x 6 cm and 5 cm x 5 cm double-paddle peroneal flap was designed. c The double-paddle peroneal flap after revascularization. d Final post-op photo at follow-up visit (DOC 2207 kb)

Supplementary Fig. 3

A double-paddle peroneal flap with a bulk of flexor hallus longus muscle. One cutaneous paddle could be used in the reconstruction of hypopharynx, and the other could be used for outer wound coverage. The adjustable muscle bulk could be the defect filler (DOC 1958 kb)

Supplementary Table 1

Patient characteristics. *C, circumferential; NC, Non-circumferential, **The same patient, the second operation was mainly due to esophageal stricture, resulting from wound infection and fistula formation, ***The medical record only showed that the patients resumed oral intake without mentioning specific type of diet, ****The patient became NG feeding at postop 9 month due to stenosis, #Double-paddle peroneal flap, as in Supplemental Fig. 2(b) and 2(c), ##Calculated based on available data and expressed as mean ± SD (DOC 52 kb)

Supplementary Table 2

Comparison between circumferential and non-circumferential groups. *mean ± SD (DOC 38 kb)

Supplementary Table 3

Complication-specific comparison between each reconstruction option. *Number of flaps, **Extracted from Piazza et al paper, Ref. [11] (DOC 29 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lin, YS., Liu, WC., Chen, LW. et al. Peroneal Flap in Hypopharyngeal Reconstruction. Ann Surg Oncol 20, 4356–4361 (2013). https://doi.org/10.1245/s10434-013-3244-7

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-013-3244-7

Keywords

Search

Navigation