Diet Outcome in Patients With Hypopharyngeal Defects Repaired With Different Reconstruction Flaps: A Comparative Study

Objectives To assess potential risk factors influencing diet outcomes after reconstruction of subtotal hypopharyngeal defects using free patch‐ or tube‐shaped anterolateral thigh (ALT) fasciocutaneous flaps. Study Design Retrospective cohort study. Setting First‐level referral hospital. Methods Between January 2011 and December 2020, we studied hypopharyngeal cancer patients who underwent the reconstruction of hypopharyngeal defects using free patch‐ or tube‐shaped ALT fasciocutaneous flaps. The choice between patch‐ or tube‐shaped ALT flaps depended on the defect's nature, favoring patch‐shaped for subtotal defects and tube‐shaped for circumferential defects. A restricted diet was characterized by a history of enterostomy or endoscopic esophageal dilation treatment postreconstruction. We analyzed patients with restricted diets at 1‐ and 3‐year follow‐up visits. Results Ninety‐eight patients were enrolled; 39 patch‐shaped flaps, and 59 tube‐shaped flaps. No significances were noted in demographics, postoperative radiotherapy (RT) or chemotherapy, rates of free flap reoperation/salvage, or complications. However, a significant difference emerged in diet outcomes at the 1‐year follow‐up (P = .005). The rate of a restricted diet was 6.08 times higher in patients with tube‐shaped flaps compared to patch‐shaped flaps (95% confidence interval [CI]: 1.95‐18.94). Stratifying based on postoperative RT revealed a 5.47 times higher rate of a restricted diet in tube‐shaped flap recipients compared to patch‐shaped flap recipients (95% CI: 1.44‐20.48). No significances were observed in 5‐year survival rates. Conclusion Concerning postoperative RT, patch‐shaped flaps exhibited a lower incidence of a restricted diet compared to tube‐shaped flaps. Preservation of the posterior mucosa may play a crucial role in preventing RT‐induced esophageal stricture.