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76th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

04.05. - 08.05.2005, Erfurt

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Reconstruction of Defect Following Resection of Hypopharyngeal, Base of Tongue and Laryngeal Carcinoma by Means of a Bilateral Neurovascular-Pedicled Infrahyoidal Muscle-Fascia Flap or `Bridge-Flap´

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  • corresponding author Hermann Seeber - HNO-Klinik, Dessau
  • Michaela Ranta - HNO-Klinik, Dessau
  • Kathrin Steinbach - HNO-Klinik, Dessau

Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie. 76. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e.V.. Erfurt, 04.-08.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05hno223

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/hno2005/05hno046.shtml

Published: September 22, 2005

© 2005 Seeber et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

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Introduction: Reconstruction of large mucosal defects following resection of hypopharyngeal, base of tongue and laryngeal carcinoma is mainly carried out with a free radial forearm flap, less so with pedicled regional or distant flaps.

The reconstruction by free transfer of tissue requires more surgical resources in conjunction with a second wound and a second surgical team. The neurovascular pedicled infrahyoidal muscle-fascia flap (NIMF) according to REMMERT as a regional flap combines the advantage of quick dissection and active muscle contraction when swallowing if the superior root of the deep cervical ansa is preserved. REMMERT describes a bilateral NIMF by lifting and suturing both flaps separately. However we used the bilateral NIMF not separately but joined as `Bridge-Flap´.

Method: The bilateral NIMF as `Bridge-Flap´ is dissected from medial to lateral from the thyroid cartilage without separation in the midline until it can be lifted off completely from the larynx. Then the larynx with the remaining tumour can be dissected under the `Bridge-Flap´ cranially.

Results: In 17 patients unilateral NIMF were lifted. In 4 patients the reconstruction of the defect was achieved by a bilateral NIMF as `Bridge-Flap´ with one patient having only a remaining pharyngeal wall of 1-2cm width. Postoperative healing of the flap and swallowing were undisturbed in all patients. Also postoperative radiotherapy did not cause any limitation of swallowing due to the flap used or other complications in any of the patients treated.

Discussion: All used flaps either unilateral or bilateral `Bridge-Flaps´ healed without any complications when attention was paid to contraindications of using NIMFs. These contraindications are: metastatic disease of the vascular pedicle, tumour invasion into external laryngeal muscles, disconnected or uncertain blood supply. The NIMF as `Bridge-Flap´ is a suitable alternative for free transfer of tissue due to its quick and relatively easy dissection, its size of up to 13x10cm, its mouldability to match the defect, its stable blood supply without the need for anticoagulation and the avoidance of a second surgical wound.