Comparison of the outcomes of anterolateral thigh flap and peroneal flap in total laryngectomy reconstruction

Background: We usually use an ALT or peroneal flap in total laryngectomy reconstruction, depending on the surgeons' preference. No direct comparison of the outcomes of the ALT flap and peroneal flap exists. Methods: From 2014 to 2022, we reviewed patients who had total laryngectomy and were reconstructed with an ALT flap and peroneal flap. Patient characteristics and surgical outcomes were collected and compared. Results: The peroneal group had a significantly higher risk of neopharynx leakage (40% vs. 13.2%, p =.020) and late pharyngocutaneous fistula formation (30% vs. 5.3%, p =.009) than the ALT group. Peroneal flap was found to be the only independent risk factor for neopharynx leakage (p =.025, odds ratio [OR] = 5.5) and late pharyngocutaneous fistula formation (p =.02, OR = 7.7) in multivariate logistic regression. Conclusion: In the reconstruction of total laryngectomy, the ALT flap is preferable over the peroneal flap.