Comparison of Outcomes Between Free Ileocolonic and Tube-Shaped ALT Fasciocutaneous Flaps in Total Hypopharyngeal Defect Reconstruction.

Abstract

This study compares the outcomes of free ileocolonic and tube-shaped anterolateral thigh (ALT) fasciocutaneous flaps in reconstructing total hypopharyngeal defects. A retrospective analysis was conducted on 76 patients who underwent reconstruction with either an ileocolonic flap (n = 20) or a tube-shaped ALT flap (n = 56) between 2011 and 2021. Primary outcomes included dietary tolerance at 1 and 3 years, pharyngocutaneous fistula rates, and survival. Statistical analyses assessed group differences in complications and dietary restrictions. The ileocolonic flap group demonstrated superior dietary outcomes at 1 and 3 years (90% vs. 62.5% and 90% vs. 51.4%, respectively) but had a higher fistula rate (25% vs. 7.1%, p = 0.048). No significant differences in survival were observed between the groups. The ileocolonic flap offers better long-term dietary outcomes despite higher early fistula rates. Further research is recommended to optimize flap selection for hypopharyngeal reconstruction.