The super thin external pudendal artery (STEPA) free flap for oropharyngeal reconstruction – A case report

The radial forearm flap is one of the most used micro‐anastomotic flaps in cervicofacial reconstruction in a carcinological context. This flap is an ideal in terms of reliability and fineness; it has, however, some disadvantages in terms of the functional and aesthetic complications of its donor site. In alternative to a radial forearm free flap, we report the use of the free super thin external pudendal artery flap (STEPA flap) for an oropharyngeal reconstruction. The aim was to decrease the donor site morbidity. A 71‐years‐old man with a T2N0M0 oropharyngeal squamous cell carcinoma has undergone surgical treatment. A left STEPA free flap was performed to reconstruct a defect about 8 × 6 cm2. This flap was designed as a half‐scrotal free flap sized 9 × 7 cm2 and was inset after tunneling of the pedicle at the floor of the mouth. A surgical revision was needed on the 15th day postoperative for disunion. There was no skin flap failure. After 12 month of follow‐up, no complication was observed at the donor site and no erectile dysfunction was recorded. Its characteristics in terms of fineness, flexibility, ease of conformation, and pedicle length are similar to those of the radial forearm flap with less aesthetic and functional sequelae of the donor site. The STEPA flap may be a promising free flap in oropharyngeal or oral cavity reconstruction

Risk Factors for Pharyngocutaneous Fistula After Total Pharyngolaryngectomy

Purpose:To evaluate the risk factors of pharyngocutaneous fistula after total pharyngolaryngectomy (TPL) in orderto reduce theirincidence and propose a perioperative rehabilitation protocol.Materials and Methods:This was a multicenter retrospectivestudy based on 456 patients operated for squamous cell carcinoma by total laryngectomy or TPL. Sociodemographic, medical,surgical, carcinologic, and biological risk factors were studied. Reactive C protein was evaluated on post-op day 5. Patients weredivided into a learning population and a validation population with patients who underwent surgery between 2006 and 2013 andbetween 2014 and 2016, respectively. A risk score of occurrence of salivary fistula was developed from the learning population dataand then applied on the validation population (temporal validation).Objective:To use a preoperative risk score in order tomodify practices and reduce the incidence of pharyngocutaneous fistula.Results:Four hundred fifty-six patients were included,328 in the learning population and 128 in the validation population. The combination of active smoking over 20 pack-years, ahistory of cervical radiotherapy, mucosal closure in separate stitches instead of running sutures, and the placement of a pedicleflap instead of a free flap led to a maximum risk of post-op pharyngocutaneous fistula after TPL. The risk score was discriminantwith an area under the receiver operating characteristic curve of 0.66 (95% confidence interval [CI]¼0.59-0.73) and 0.70 (95% CI¼0.60-0.81) for the learning population and the validation population, respectively.Conclusion:A preoperative risk score couldbe used to reduce the rate of pharyngocutaneous fistula after TPL by removing 1 or more of the 4 identified risk factors