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Video

Head and Neck Surgery

(A592) Outcomes of Microvascular Free Flap Repair for Non-Malignant Pharyngeal and Esophageal Perforations: A Systematic Review

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • Arati Bendapudi, BS

    Medical Student
    UTMB John Sealy School of Medicine
    Celina, Texas, United States

    • Co-Author(s)

  • Evan S. Pistone, BBA

    Medical Student
    University of Texas Medical Branch
    Galveston, Texas, United States

  • Delaney Shiu Clark, BS

    Medical Student
    University of Texas Medical Branch At Galveston
    Galveston, TX, United States

  • Shahrukh R. Ali, MD

    Resident
    University of Texas Medical Branch Hospitals
    Richmond, TX, United States

  • OC

    Orly Coblens, MD

    Department of Otolaryngology, University of Texas Medical Branch, United States

  • Sepehr Shabani, MD

    Assistant Professor
    City of Hope National Medical Center
    Duarte, California, United States

    • Senior Author(s)

  • Viran J. Ranasinghe, MD

    Assistant Professor
    Department of Otolaryngology, University of Texas Medical Branch
    Galveston, Texas, United States

Disclosure(s):
Arati Bendapudi, BS: No relevant relationships to disclose.
Evan S. Pistone, BBA: No relevant relationships to disclose.
Delaney Shiu Clark, BS: No relevant relationships to disclose.
Shahrukh R. Ali, MD: No relevant relationships to disclose.
Sepehr Shabani, MD: No relevant relationships to disclose.
Viran J. Ranasinghe, MD: No relevant relationships to disclose.


Introduction: Esophageal and pharyngeal perforations are life-threatening emergencies that can arise from causes including caustic injury and iatrogenic factors. Regional pedicled flaps are used traditionally to repair these perforations, however, free flaps may sometimes be better suited due to their pliability in covering larger defects. This systematic review aims to provide an overview of outcomes following microvascular free tissue transfer for non-malignant perforations of the pharynx and esophagus.

Methods: A systematic search was conducted in October 2024 using Ovid Medline and SCOPUS to identify peer-reviewed studies published in English between 1980 and 2024. 1,896 articles were originally identified. Three independent reviewers screened the articles, and studies were eligible for inclusion if they addressed non-malignant perforations and described the use of microvascular flap repair in the pharynx and cervical esophagus.

Results: A total of 47 articles describing 90 flaps were included, of which 19 articles described 44 free flaps specifically. The median patient age was 44 (range: 1.6-83), and 62.5% were male. The average recovery time was 29.46 days (Median:18). Swallowing ability was preserved in 81.8% of cases. The most common free flaps used were the omental flap (25%) and the jejunal flap (20%). Iatrogenic complications most frequently required repair (56%) , and these injuries were significantly more likely to be repaired with omental flaps compared to other free flaps (p < 0.001). The most common complication associated with free flap repair was stricture, whereas in pedicled flaps, the most common complication was leakage. Differences in recovery time in the two groups were not significant, nor were differences in complications.

Conclusions: This review highlights the need for further analysis of differences in outcomes between free and regional flap repair. Data was limited due to the relatively small number of free flap articles. Future research should explore long-term outcomes of various flaps to provide clearer guidelines for when free tissue transfer may be indicated.