title: Tube-in-a-tube anterolateral thigh flap for reconstruction of a complex esophageal and anterior neck defect.
abstract: Restoration of a functional digestive track along with acceptable external neck coverage traditionally requires 2 separate flaps. We present a case of a 65-year-old man with a large cervical and esophageal defect treated successfully with a single anterolateral thigh (ALT) free flap. This patient had been treated with primary chemoradiation for laryngeal cancer, and subsequently, developed a severe esophageal stricture. He had undergone prior multiple attempts at reconstruction with a pectoralis major, radial forearm, and deltopectoral flaps, skin grafts, and gastric pull-up, which had all failed. We used an ALT free flap that was designed in a "tube-in-a-tube" fashion to simultaneously reconstruct the cervical esophagus while resurfacing the anterior neck. The patient successfully restarted a liquid diet on the 19th postoperative day. Tube-in-a-tube ALT flap design is a reliable and efficient way to concurrently restore esophageal continuity and provide anterior neck coverage in a single-stage procedure.
authors.affiliation: From the *Plastic Surgery of West Michigan and College of Human Medicine, Michigan State University, Grand Rapids, MI; and †Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Palo Alto, CA.
authors.forename: Ewa
authors.initials: E
authors.lastname: Komorowska-Timek
authors.forename: Gordon K
authors.initials: GK
authors.lastname: Lee
mesh_terms: D000368:Aged; D004940:Esophageal Stenosis / Q000209:etiology / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D058752:Free Tissue Flaps; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D008297:Male; D009333:Neck / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013848:Thigh