Microvascular Transfer of The Dorsalis Pedis Skin Flap for Hypopharyngeal Reconstruction
R. M. ZUKER
R. T. MANKTELOW
The dorsalis pedis skin flap can be used for lining in most areas of the head and neck, but it is particularly useful for areas of difficult access (1, 2, 3, 4). The pharyngoesophageal area is often difficult to reconstruct with conventional pedicle flaps, but it poses no problem when a free flap is used (5, 6, 7).
The dorsalis pedis skin flap is useful in the smaller hypopharyngeal defects, particularly when a tube is not needed because the defect is not circumferential. The flap is especially useful when the more commonly used flaps, such as the pectoralis major or deltopectoral, have already been used. This flap provides ease of access, thin pliable tissue for mucosal resurfacing, a long pedicle, and a remote site (nonradiated tissue).
FLAP DESIGN AND DIMENSIONS
The procedure should be planned in reverse, even though the extent of the defect is not precisely known. One should know, however, whether a portion of the anterior or posterior wall can be preserved. The more likely side of available recipient vessels is chosen, and then the more appropriate foot is selected. (For example, with a hypopharyngeal defect with a residual posterior wall and vessels likely on the right, select the left foot.)
The flap can extend distally to the interdigital web spaces (10). Its proximal extent is to the distal portion of the extensor retinaculum. Its lateral boundaries are 1 cm medial to the extensor hallucis longis tendon and 1 cm lateral to the extensor digiti quinti tendon (Fig. 228.1B).