Circumferential pharyngeal reconstruction: History, critical analysis of techniques, and current therapeutic recommendations

Abstract

Reconstruction of circumferential pharyngeal defects following total pharyngolaryngectomy presents major challenges with respect to surgical morbidity and restoration of functional deficits, which are often made more demanding by the increasing trend to utilize primary chemoradiation protocols with surgery reserved for salvage cases. The present review evaluates the reconstructive techniques described in the literature, including historical techniques as well as more recent innovative methods. Each technique is critically appraised with particular reference to postoperative morbidity and functional rehabilitation. Treatment recommendations are made based on the available evidence.

Risk factors for tracheal necrosis after total pharyngolaryngectomy

“…This use of the mesenteric flap can reduce the risks of deep infection and fistula formation . Even if tracheal necrosis occurs, the mesenteric flap serves as a physical barrier between the trachea and the surrounding tissues and prevents the inflammation from spreading to the great vessels …”

Single free anterolateral thigh flap for simultaneous reconstruction of composite hypopharyngeal and external neck skin defect after head and neck cancer ablation

“…5 Besides, a high incidence of fistula and stricture when using the radial forearm free flap for pharyngeal reconstruction has encouraged reconstructive surgeons to explore other alternatives. 10 Therefore, reconstructions with two flaps for pharyngeal composite defects are more frequently encountered. Double free flaps can be used.…”

Traditional transcutaneous approaches in head and neck surgery

“…The goal of any reconstruction in the pharyngeal area is the reestablishment of form (pharyngeal tube) and function (speech, swallowing) with minimal postoperative complications (pharyngocutaneous fistula, pharyngeal stenosis) [130], [131]. The choice of the reconstructive approach is dictated by defect size and position as well as factors like previous radiation or chemoradiation and concomitant medical diseases [130].…”

“…The choice of the reconstructive approach is dictated by defect size and position as well as factors like previous radiation or chemoradiation and concomitant medical diseases [130]. However, the 5-year-survival-rates remain rather disappointing in spite of advances in reconstructive techniques and have to be taken into account for the choice of treatment modality [130], [131]. Disa et al classify hypopharyngeal defects into 4 categories and developped an algorithm for reconstruction [132].…”