• Peter C Revenaugh, Heather H Waters, Joseph Scharpf, P Daniel Knott, and Michael A Fritz.
• Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA.
• JAMA Facial Plast Surg. 2013 Jul 1; 15 (4): 287-91.

ImportanceMethod of direct clinical monitoring of tissue perfusion in free tissue reconstruction of pharyngeal defects.ObjectiveTo describe a novel and effective method of incorporating a cutaneous skin paddle into laryngopharyngectomy reconstruction for direct clinical monitoring of anterolateral thigh free flaps.DesignRetrospective review of pharyngoesophageal reconstruction for laryngopharyngectomy defects performed between August 1, 2008, and March 1, 2011, using the anterolateral thigh flap.SettingTertiary care academic medical center.ParticipantsConsecutive patients undergoing laryngopharyngectomy where free tissue transfer is indicated.InterventionsAnterolateral thigh free flap reconstruction with suprastomal cutaneous monitoring paddle.Main Outcome MeasuresPostoperative complications, including flap failure, fistula, and stricture. Postoperative functional outcomes of swallowing and vocal capability were also measured.ResultsTwenty-one patients (mean age, 62.2 years; range, 39-81 years) underwent total laryngectomy with near-total or total pharyngectomy and immediate reconstruction with an anterolateral thigh free flap. The reconstructions included a cutaneous monitor paddle distal to the pharyngoesophageal anastomosis. Twenty patients were treated for squamous cell carcinoma and received either adjuvant or neoadjuvant radiation therapy. There were no partial or total flap losses. A late pharyngocutaneous fistula occurred at 6 weeks in 1 patient (5%), requiring exploration, and anastomotic stricture occurred in 4 patients (19%). All patients except 1 were able to swallow solid foods at a mean follow-up of 11.1 months. Nineteen patients (90%) underwent tracheoesophageal puncture and attained an intelligible voice. One patient (5%) had stomal stenosis requiring surgical management.Conclusions And RelevanceThe suprastomal cutaneous monitoring paddle enables direct monitoring of an otherwise buried reconstructive flap. This method allows direct clinical observation for microvascular compromise without a need for further procedures and without any increase in morbidity or compromise of speech and swallow functions.Level Of Evidence4.

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