title: Tubed, folded radial forearm free flap for pharyngeal reconstruction and voice rehabilitation.
abstract: Reconstruction after total laryngectomy ideally includes restoration of voice with protected swallowing. Local flaps and tracheo-esophageal puncture with a prosthesis are widely used to accomplish this. Persistent problems, perhaps inherent to this solution, have led to the recent use of a tubed, folded radial forearm free flap for postlaryngectomy reconstruction. This flap has produced a good voice with low phonation pressures and minimal aspiration in 7 patients. A new configuration for this flap is described and 3 patients reported. Our flap's advantages include a simplified pedicle path, ease of construction, remote microanastomosis, and safer revision. Both patients with surviving flaps rapidly developed a good voice after reconstruction. Mild aspiration in 1 delayed oral intake and forced a successful revision. Our reconfigured flap may have some technical advantages, survives to length, and restores a good voice without significant aspiration. This and its simple care make it popular with patients. Development of this flap holds promise of more complete reconstruction after total laryngectomy.
authors.affiliation: Samuel S. Stratton VA Hospital, Albany, NY.
authors.forename: A
authors.initials: A
authors.lastname: Hussain
authors.forename: J L
authors.initials: JL
authors.lastname: Dolph
authors.forename: J F
authors.initials: JF
authors.lastname: Padilla
authors.forename: S
authors.initials: S
authors.lastname: Silver
mesh_terms: D005542:Forearm; D006801:Humans; D007825:Laryngectomy / Q000534:rehabilitation*; D010614:Pharynx / Q000601:surgery*; D011183:Postoperative Complications; D013524:Surgical Flaps / Q000379:methods*; D014831:Voice