Pharyngoesophageal Reconstruction with A Tubed Radial Forearm Free Flap: A Case Report

Abstract

Hypopharyngeal carcinoma is one of the most aggressive primary head and neck cancers, often managed through partial or total laryngopharyngectomy. Reconstruction after such surgeries remains a challenging procedure that often requires the use of free flaps. A 63-year-old male patient with in-situ squamous cell carcinoma of the left vocal cord treated with total pharyngolaryngectomy and primary reconstruction with a left radial forearm free flap, complicated by flap necrosis, which ended up in dismantling and gastrostomy. He was referred to the Plastic and Reconstructive Surgery Department at Centro Medico Nacional 20 de Noviembre, Mexico in 2023 to assess the reconstructive options for the hypopharynx and cervical esophagus defect. A tubular right radial forearm free flap was designed forming the anterior wall of the hypopharynx and cervical esophagus and a posterior wall for the external defect. Twelve months after his surgery, he continues tolerating oral intake without signs of stenosis or tumor recurrence. The objective in this case was based on restoring the continuity of the digestive tract and swallowing function, as well as providing skin coverage of the defects, and preventing serious complications. The radial forearm free flap has versatility in the tubular construction and a low leak rate, as well as an adequate skin island size. Conclusion: The pharyngoesophageal reconstruction with a tubed forearm free flap has favorable outcomes for restoring the gastrointestinal tract without further complications.