Diet Outcome in Patients With Hypopharyngeal Defects Repaired With Different Reconstruction Flaps: A Comparative Study

Pin-Keng Shih; Jian-Xun Chen; Shane D Morrison; Mei-Chen Lin; Ti-Hao Wang; Shih-Chi Wu

doi:10.1002/ohn.792

Diet Outcome in Patients With Hypopharyngeal Defects Repaired With Different Reconstruction Flaps: A Comparative Study

Otolaryngol Head Neck Surg. 2024 Apr 26. doi: 10.1002/ohn.792. Online ahead of print.

Authors

Pin-Keng Shih^{1

2}, Jian-Xun Chen^{1

2}, Shane D Morrison³, Mei-Chen Lin^{1

4}, Ti-Hao Wang^{1

5}, Shih-Chi Wu^{1

6}

Affiliations

¹ School of Medicine, China Medical University, Taichung, Taiwan.
² Department of Surgery, China Medical University Hospital, Taichung, Taiwan.
³ Department of Surgery, Division of Plastic Surgery, University of Washington Medical Center, Seattle, Washington, USA.
⁴ Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
⁵ Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.
⁶ Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan.

PMID: 38668643
DOI: 10.1002/ohn.792

Abstract

Objectives: To assess potential risk factors influencing diet outcomes after reconstruction of subtotal hypopharyngeal defects using free patch- or tube-shaped anterolateral thigh (ALT) fasciocutaneous flaps.

Study design: Retrospective cohort study.

Setting: First-level referral hospital.

Methods: Between January 2011 and December 2020, we studied hypopharyngeal cancer patients who underwent the reconstruction of hypopharyngeal defects using free patch- or tube-shaped ALT fasciocutaneous flaps. The choice between patch- or tube-shaped ALT flaps depended on the defect's nature, favoring patch-shaped for subtotal defects and tube-shaped for circumferential defects. A restricted diet was characterized by a history of enterostomy or endoscopic esophageal dilation treatment postreconstruction. We analyzed patients with restricted diets at 1- and 3-year follow-up visits.

Results: Ninety-eight patients were enrolled; 39 patch-shaped flaps, and 59 tube-shaped flaps. No significances were noted in demographics, postoperative radiotherapy (RT) or chemotherapy, rates of free flap reoperation/salvage, or complications. However, a significant difference emerged in diet outcomes at the 1-year follow-up (P = .005). The rate of a restricted diet was 6.08 times higher in patients with tube-shaped flaps compared to patch-shaped flaps (95% confidence interval [CI]: 1.95-18.94). Stratifying based on postoperative RT revealed a 5.47 times higher rate of a restricted diet in tube-shaped flap recipients compared to patch-shaped flap recipients (95% CI: 1.44-20.48). No significances were observed in 5-year survival rates.

Conclusion: Concerning postoperative RT, patch-shaped flaps exhibited a lower incidence of a restricted diet compared to tube-shaped flaps. Preservation of the posterior mucosa may play a crucial role in preventing RT-induced esophageal stricture.

Keywords: diet outcome; hypopharyngeal defects; patch‐shaped flaps; reconstruction; tube‐shaped flaps.