Pharyngoesophageal Reconstruction With the Medial Sural Artery Perforator Flap After Total Laryngopharyngectomy: A New Method

Background: The medial sural artery perforator (MSAP) flap has become a popular target in head and neck reconstruction. This flap has many advantages compared with other free flaps but has not yet been used in the reconstruction of circumferential haryngoesophageal defects. Methods: Reconstruction of pharyngoesophageal circumferential defects using the MSAP flap was performed in 4 patients. The design of the flap was based on the perforators, which were confirmed by endoscopy. The MSAP flap was tubed and anastomosed end to end to the esophagus. The artery was anastomosed to the superior thyroid arteries, whereas the vein was anastomosed to the internal jugular vein. Results: All the flaps survived. All 4 patients gained acceptable speech and swallow function. One patient developed an infection at the donor site, a second developed fistulas, and a third experienced stricture. All complications were successfully treated. Conclusions: Here, we demonstrated the use of the MSAP flap in reconstruction of circumferential pharyngoesophageal defects. Further application and follow-up studies should be performed.

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