Three Simultaneous Free Flaps to Reconstruct a Complex Frozen Neck and a Large Hypopharyngeal Fistula

Frozen neck and hypopharyngeal fistula are sometimes present after tumor ablation of the larynx, multiple local surgeries with scar tissue, and radiotherapy and chemotherapy. This multiorgan involvement requires 1 or even 2 flaps. We present a 63-year-old heavy smoker with frozen neck tissue and simultaneous large hypopharyngeal fistula and neck defect. After careful preoperative planning, he was successfully treated with 3 simultaneous free flaps: 2 anterolateral thigh flap (ALT) and 1 lateral arm flap (LAF). One ALT was used as a patch to restore the hypopharynx continuity. A second ALT was used to cover the anterior neck defect and the LAF flap was used to reconstruct the submandibular area. The flaps survived and the patient had a 5 mm proximal fistula which was sutured, and he was able to eat per mouth. By combining multiple free flaps, we were able to restore the function of the hypopharynx and to cover the esthetic units of the neck by avoiding the "turkey neck" appearance. Address correspondence and reprint requests to Magdalena Chirila, MD, PhD, Emergency District Hospital, Ear Nose and Throat Department, 4-6 Clinicilor Str., Cluj-Napoca 400006, Romania; Iuliu Hatieganu University of Medicine and Pharmacy, Ear Nose and Throat Department, Cluj-Napoca, Romania; E-mail: chirila_magda@yahoo.com Received 20 July, 2018 Accepted 5 September, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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