ArticleEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery2026
Re-evaluating the role of pedicled pectoralis major flap in subtotal hypopharyngeal reconstruction.
Article in European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeWithout requiring microvascular anastomosis, could the pedicled pectoralis major myocutaneous flap (PPMMF) represent a simpler, safer, and more efficient alternative to the free anterolateral thigh fasciocutaneous flap (FALTFF) in subtotal hypopharyngeal defect reconstruction?
methodsThis retrospective study analyzed 58 patients with hypopharyngeal cancer who underwent subtotal defect reconstruction using either a pedicled pectoralis major myocutaneous flap (PPMMF, n = 21) or a free anterolateral thigh fasciocutaneous flap (FALTFF, n = 37) between January 2011 and December 2024. Evaluated outcomes included postoperative complications, dietary function at 1 and 3 years, and 5-year survival. A restricted diet was defined as dependence on enterostomy feeding or the need for pharyngoesophageal dilation.
resultsFALTFF procedures were associated with longer operative times (14.79 vs. 10.94 h, p = 0.0001), longer ICU stays (4.92 vs. 2.62 days, p < 0.001), and slightly higher total costs (390,110 vs. 373,900 NTD, p = 0.0484). Despite these factors, FALTFF showed superior safety, with lower flap salvage rates (13.51% vs. 38.10%, p = 0.0487) and no cases of pharyngocutaneous fistula (0% vs. 14.29%, p = 0.0431). Dietary outcomes favored FALTFF, though not reaching statistical significance (regular diet at 1 year: 91.89% vs. 71.43%, p = 0.0593; at 3 years: 80.95% vs. 60.00%, p = 0.2600), indicating a consistent 20% reduction in dietary restriction. Five-year survival rates were similar between the two groups.
conclusionFALTFF demonstrated superior safety with fewer complications and reoperations, and no fistulas, outweighing its slightly longer surgery and higher initial costs.
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