Flap selection for circumferential pharyngeal reconstruction.
Curr Opin Otolaryngol Head Neck SurgJun 9, 2026 (epub)
Jonathan M Bernstein, Margaret M Coffey, Simon H Wood
✦ AI-curated · Sources linked
In 30 seconds
This narrative review synthesizes findings from six systematic reviews and meta-analyses on flap selection for circumferential pharyngeal reconstruction after total laryngopharyngectomy. The free jejunal flap (FJF) shows the lowest fistula rate of 8-11% and a 93% probability of being the best option for fistula avoidance among 1357 patients. No randomized trials were identified.
Key findings
- FJF has the lowest fistula rate of 8-11% and a 93% probability of ranking first for fistula avoidance.
- Tubed ALT showed non-significant trends toward lower flap failure and 30-day mortality.
- Adjuvant radiation therapy increases FJF stricture risk nearly five-fold, particularly in non-salvage cases.
- The U-shaped pectoralis major flap had the lowest stricture rate in the network meta-analysis.
Why it matters
Understanding the comparative effectiveness of different flaps for pharyngeal reconstruction is crucial for optimizing patient outcomes, particularly in managing complications like fistulas and strictures.