Modification of the anterolateral thigh free flap design for reconstruction after laryngo-pharyngoesophagectomy

The anterolateral thigh free flap (ALTFF) has become the favourable fasciocutaneous flap for reconstruction of laryngo-pharyngoesophagectomy (LPO) defects. Reconstruction of these defects can be challenging. We report our experience with a new flap design based on the traditional ALTFF template for single-stage reconstruction of circumferential LPO defects with anterior neck skin deficits in previously irradiated patients. The design uses the traditional tubed skin island to create the neopharynx and also utilises the natural dog-ears from the thigh as a second vascularised skin island that can be used to fill dead space or externalised to resurface the neck. This addresses the issues of monitoring the internal skin paddle and also of replacing anterior neck skin deficits with a single flap.Level of Evidence: Level V, therapeutic study.