Gastro-omental free flap in the reconstruction of the unfavourable hypopharyngeal defects: A functional assessment

Reconstructive options after total laryngectomy with subtotal or circumferential hypopharyngectomy and cervical esophagectomy

“…a Indicates that the entire series is composed of patients in whom the jejunum free flap was harvested laparoscopically. Even though, in extreme situations like these, swallowing and effective speech production can seem a luxury, Chahine et al [100] and Patel et al [102] recently reported a 90% rate of full oral diet with minimal dysphagia (in one-third of cases after endoscopic dilatation of distal stenoses) and functional speech after TEP placement in 70% of patients treated by gastroomental transposition [102]. c Series of patients in whom jejunum free flaps were always covered by pectoralis major myofascial pedicled flap.…”

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

“…Recently, several larger series have reported the use of gastro‐omental free flap reconstruction of complicated high‐risk wounds. In 2008, Chanine et al60 reported 15 patients with advanced recurrent hypopharyngeal carcinoma necessitating complex soft tissue reconstruction, in addition to circumferential pharyngeal reconstruction, because of the toxic tissue effects of previous chemoradiotherapy, surgery, and/or neck abscess. Although there were no complete flap failures, there were 2 partial flap failures that resulted in pharyngo‐cutaneous fistula requiring secondary pectoralis major flap reconstruction.…”

“…Although many patients (range, 60% to 88%) undergoing JFF were able to return to oral diet, many of these patients experienced dysphagia secondary to hyperperistalsis 44–46. In contrast, up to 90% of patients who underwent reconstruction with the gastro‐omental free flap acquired a full oral diet with minimal dysphagia, which is likely related to the mucous secretion from the transferred gastric mucosa 60, 62. However, endoscopic dilatation of pharyngoesophageal stricture is necessary in up to 30% of cases 60, 62…”

Utility of the gastro-omental free flap in head and neck reconstruction

“…Chahine et al [21 ] reported a series of 15 cases of gastroomental free flap reconstruction of circumferential hypopharyngeal defects, which were considered unsuitable for the more commonly employed jejunum or radial forearm flaps. Except for one case requiring reconstruction following necrosis of a jejunum flap, all remaining cases presented with advanced recurrent hypopharyngeal carcinoma.…”