Re-evaluating the role of pedicled pectoralis major flap in subtotal hypopharyngeal reconstruction.

PURPOSE: Without 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?

METHODS

This 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.

RESULTS

FALTFF 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.

CONCLUSION

FALTFF demonstrated superior safety with fewer complications and reoperations, and no fistulas, outweighing its slightly longer surgery and higher initial costs.