# Use of double flaps in pharyngo-laryngo-esophageal reconstructions: a retrospective review

## TL;DR

This study reviews the use of double flaps in reconstructing defects after pharyngeal and esophageal surgeries, highlighting their effectiveness and complications.

## Contribution

The paper provides a systematic review of double flap techniques in pharyngo-laryngo-esophageal reconstructions, emphasizing their use in complex cases.

## Key findings

- Pectoralis flap is the most common pedicled flap used in these reconstructions.
- Jejunum flap is the most frequently used free flap in the reviewed cases.
- Approximately 10.8% of patients experienced minor complications like partial necrosis.

## Abstract

This article aims to review techniques and applications for using double flaps (both free and pedicled, and their combinations) in reconstructing defects from total pharyngolaryngectomies (TPL) or pharyngolaryngo-esophagectomies.

This systematic review followed PRISMA 2020 guidelines. Three authors screened articles, selecting and extracting data on malignancy characteristics, reconstructive techniques, outcomes and complications.

Eleven articles were reviewed, involving 176 oncologic patients. Most patients (39.8%) had defects in the larynx, hypopharynx and cervical skin, while in 31.8% the double flaps were used to restore the pharynx and protect the visceral anastomosis. In most studies included, preoperative treatments were administered, including radiotherapy (RT), concurrent chemoradiotherapy (CRT), and surgery, either alone or in combination. A wide variety of pedicled and free flaps were described. The most common pedicled flap is the pectoralis flap (81 patients, 46%), while the most used free flap is the jejunum flap (124 patients, 70%).

19 patients (10.8%) manifested partial necrosis or encountered minor complications postoperatively. 5 patients necessitated a surgical revision of the flap.

The literature on surgical reconstructions following TPL or pharyngolaryngo-esophagectomies using double flaps is limited. The use of double flap is indicated in cases of TPL with extensive skin defect but is also recommended in case of salvage TPL without skin defect.

The online version contains supplementary material available at 10.1007/s00405-025-09456-z.