Design and application of submental island flap to reconstruct non-circumferential defect after hypopharyngeal carcinoma resection: a prospective study of 27 cases

Abstract

Background

This study investigated the effects of reconstruction of hypopharyngeal non-circumferential defects with a submental island flap after ablation of hypopharyngeal carcinoma.

Objectives

The purpose of our study was to identify advantages and limitations of the submental flap for reconstruction of non-circumferential hypopharyngeal defects.

Methods

A total of 27 patients who had stage II–IV hypopharyngeal cancer and underwent pharyngeal reconstruction with a submental flap by the senior author in both Department of Otolaryngology Head Neck Surgery, Chinese PLA General Hospital and Department of Otolaryngology Head Neck Surgery, Beijing Friendship Hospital, Capital Medical University.

Results

96.3% (26/27) cases of submental island flap survived. There were two pharyngocutaneous fistulas, one recovered spontaneously, and the other was associated with flap necrosis, underwent neck debridement and flap removal. All except for one patient had decannulation of their nasogastric tube 2 weeks postoperatively. There was no evidence of a stricture or stenosis of the laryngopharynx, nor any sign of aspiration, except for one with esophageal inlet stricture caused by radiotherapy. There were two cases of obvious paraesthesia pharynges due to beard growth at the submental flap after reconstruction. 63.0% (17/27) patients are alive and 37% (10/27) have died of disease. The 3-year survival rate is 56.3% and the 5-year survival rate is 50.0%.

Conclusion

The submental flap reconstruction for moderately sized non-circumferential hypopharyngeal defects is a recommended treatment option.

Chinese abstract

背景：本研究探讨了消融下咽癌后使用颏下岛状皮瓣重建下咽非周围性缺损的效果。

目的：确定用于修复非周围性下咽部缺损的颏下皮瓣的优势和局限性。

方法：中国人民解放军总医院头颈外科和首都医科大学附属北京友谊医院耳鼻咽喉科的两位高级学者对总共27例II-IV期下咽癌患者进行了颏下皮瓣咽部重建手术。

结果：96.3％（26/27）病例的颏下岛状皮瓣成功了。有两处咽皮肤瘘, 一处自发恢复, 另一处与皮瓣坏死有关, 接受了颈清创术和皮瓣清除。除一名患者外, 所有其他患者在术后两周拔下鼻胃管。没有证据表明喉咽狭窄或狭窄, 也没有证据表明喉咽狭窄或狭窄。只有一例因放疗引起食管入口狭窄。有两例因胡须生长在颏下皮瓣而出现明显的咽部感觉异常。 63.0％（17/27）的患者还活着, 而37％（10/27）的患者死于该病。 3年生存率为56.3％, 5年生存率为50.0％。

结论：对于中等大小的非周围性下咽部缺损, 进行颏下皮瓣重建是值得推荐的治疗选择。

Keywords:

• Head and neck cancer
• submental island flap
• hypopharyngeal carcinoma
• reconstruction

Author contributions

Liangfa Liu contributed to the concept and design of project. Wenting Pang drafted the manuscript. M Shahed Qraishi helped finalise the manuscript. Aobo Zhang and Cheng Lu took part in the whole process of treatment. Jun Tian, Wanxin Li, Zhenxiao Wang and Yanbo Dong were responsible for the data collection. Shuoqing Yuan, Zihao Niu and Yiyuan Zhu were in charge of clinical follow-up.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by Research and Development Project of Scientific Research Instruments and Equipment of Chinese Academy of Sciences-major instruments project [YJKYYQ20180039], and the Digestive Medical Coordinated Development Center of Beijing Municipal Administration of Hospitals [No. XXZ0604].