title: The Value of the "Papillon" Anterolateral Thigh Flap for Total Pharyngolaryngectomy Reconstruction: A Retrospective Case Series.
abstract: OBJECTIVE
  The tubed, buried anterolateral thigh (ALT) flap is a popular reconstruction method for total pharyngolaryngectomy defects. The "papillon"-designed ALT flap, described by Hayden et al, offers an alternative method of using the ALT flap in this situation. We report our early experience with the papillon ALT flap in a patient cohort.
  
  
  METHODS
  On retrospective review, all patients who underwent reconstruction of circumferential total pharyngolaryngectomy defects with the papillon ALT flap from February 2012 to February 2015 were identified from our departmental database. Demographic and clinical data, operative details, and complications were analyzed from the records.
  
  
  RESULTS
  Seven patients were included in this study. The mean length of hospital stay was 15 days (range, 10 to 32 days). Acute complications occurred in 5 of 7 patients, namely, partial flap loss managed by a pectoralis flap (1 of 7 [14%]); an early pharyngocutaneous fistula (4 of 7 [57%]) managed by simple repair, wound packing, or delayed repair; and a donor-site hematoma (1 of 7 [14%]). At follow-up (range, 2 to 24 months), there was 1 stricture formation, but no chronic fistula. All patients were able to swallow orally.
  
  
  CONCLUSIONS
  Early results using the papillon ALT flap suggest that this technique is a viable alternative to the standard tubed ALT flap design. The advantages of this design include the following: 1) it offers simultaneous vascularized skin to resurface anterior neck skin deficiency without resorting to additional tissue elsewhere; 2) direct monitoring of the ALT flap is possible; and 3) any pharyngocutaneous fistula is exteriorized to the surface without compromising the internal neck structures and can be easily identified and repaired directly in the office.
authors.affiliation: Surgical Fellow, Oncology Program, Department of Oral and Maxillofacial Surgery, Marlene and Stewart Greenebaum Cancer Center, University of Maryland, Baltimore, MD.
authors.forename: Naseem
authors.initials: N
authors.lastname: Ghazali
authors.affiliation: Surgical Fellow, Oncology Program, Department of Oral and Maxillofacial Surgery, Marlene and Stewart Greenebaum Cancer Center, University of Maryland, Baltimore, MD.
authors.forename: Todd C
authors.initials: TC
authors.lastname: Hanna
authors.affiliation: Assistant Professor, Oncology Program, Department of Oral and Maxillofacial Surgery, Marlene and Stewart Greenebaum Cancer Center, University of Maryland, Baltimore, MD.
authors.forename: Donita
authors.initials: D
authors.lastname: Dyalram
authors.affiliation: Assistant Professor and Fellowship Director, Oncology Program, Department of Oral and Maxillofacial Surgery, Marlene and Stewart Greenebaum Cancer Center, University of Maryland, Baltimore, MD. Electronic address: jlubek@umaryland.edu.
authors.forename: Joshua E
authors.initials: JE
authors.lastname: Lubek
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000209:etiology; D017577:Cutaneous Fistula / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation*; D006085:Graft Survival; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007825:Laryngectomy / Q000534:rehabilitation*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010608:Pharyngeal Diseases / Q000209:etiology; D010611:Pharyngectomy / Q000534:rehabilitation*; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D016156:Respiratory Tract Fistula / Q000209:etiology; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods*; D015996:Survival Rate; D013848:Thigh / Q000473:pathology; D060053:Transplant Donor Site / Q000473:pathology; D016896:Treatment Outcome