Fasciocutaneous free flaps in pharyngolaryngo-oesophageal reconstruction: a critical review of the literature

Fasciocutaneous (FC) free flaps are gaining widespread popularity for the reconstruction of head and neck defects. The radial forearm free flap and the anterolateral thigh flap are now widely used for pharyngolaryngo-oesophageal (PLO) reconstruction. In many units these flaps are used in preference to enteric free flap reconstructions. This review examined the literature regarding the morbidity, mortality and functional outcomes of FC free flap reconstruction of PLO defects, particularly with respect to the recent modifications reported in the literature. A Medline search was performed for reports published between 1994 and 2005 and a total of 20 papers were reviewed. Cumulative fistula and stricture rates were 13% and 16.1%, respectively, and many surgeons have incorporated modifications in the technique to further reduce these rates. These results compared favourably to recent reports of enteric reconstructions. Functional outcome with the FC free flaps were superior to those reported with jejunal flaps, especially with regard to speech following tracheo-oesophageal puncture. Following a fasciocutaneous reconstruction, hospital admission time and ICU stay were shorter and there were fewer perioperative deaths. Based on this comprehensive review of the literature with respect to morbidity, mortality and functional outcomes, FC free flap reconstruction of the PLO defect can be considered an excellent first line treatment of these difficult defects.