A comparative study of pharyngolaryngectomy free flap reconstruction: A 12-year retrospective analysis at a single center.

A retrospective, comparative study of anterolateral thigh (ALT), jejunal free (JF), and radial forearm (RF) flap reconstruction of pharyngolaryngectomy defects between October 2012 and September 2024 was conducted. Data were collected from patient's electronic notes. Thirty-nine patients were included in the demographics and early complication analysis. Thirty-five patients were followed up for a minimum 3 months and included in the late complication and functional analysis. One ALT experienced partial flap loss requiring further reconstruction and one ALT was salvaged with a re-do anastomosis. All-cause return-to-theater rate was higher in the ALT (6/26) and RF (1/4) groups compared to the JF (1/9) group. ALT reconstructions had the lowest stricture rate (9/24) compared to JF (4/8) and RF (1/3). Fistula rates were the same in ALT and JF reconstruction, as were the rates of patients who achieved satisfactory long-term dietary outcomes. More JF reconstructions achieved satisfactory long-term speech outcomes (6/7) compared to ALT (12/23) and RF reconstructions (1/3). Better outcomes correlated with the surgeon's experience. We concluded that ALT and JF flaps are effective reconstructive options that should be performed by experienced surgeons in specialized centers.