Primary reconstruction of pharyngo-oesophageal defects in oncologic patients

Abstract

Majority of patients that undergo total or partial removal of the hypopharynx and cervical oesophagus are oncologic patients. Optimal management of head and neck malignancies requires multimodal therapy including surgical ablation, reconstruction, and adjuvant oncologic therapy. Despite aggressive surgical and adjuvant therapy, a five-year survival rate is achieved only in 25-35 %. In the presented retrospective study, the choice of reconstructive method was influenced by type, length and extent of the defect, and condition of patient. The flap was indicated when the defect not allowed for primary suture of the hypopharynx and/or cervical oesophagus. Two-team approach was used. The study was based on the data of ten patients. Radial forearm flap was used in 8 cases; pectoralis major myocutaneous flap was used in 3 patients, and ALT perforator free flap in 1 case. A total of 12 flaps were used for 10 patients. Two patients developed free flap necrosis. These necrotic flaps were substituted with pedicled pectoralis major myocutaneous flaps. The primary reconstruction of the pharyngo-oesophageal defects could be the method of choice. For the partial defects, the best choice could be a radial forearm free flap. For circumferential defects, jejunal flap could be the best. The pectoralis major pedicled flap could be a safe procedure for elderly patients with multiple medical problems (Tab. 6, Fig. 2, Ref. 34).