Reconstruction of circumferential pharyngolaryngectomy using a ‘horseshoe-shaped’ pectoralis major myocutaneous flap

Abstract

Eighteen patients underwent a circumferential pharyngolaryngectomy reconstruction post pharyngolaryngectomy. All tumours showed pharyngo-oesophageal junction invasion or circular involvement of the hypopharynx, requiring total, circumferential pharyngolaryngectomy. A pectoralis major myocutaneous flap was directly sutured to the pre-vertebral fascia. A Montgomery salivary bypass tube was introduced into the oesophagus, and a nasogastric tube was placed within it. No post-operative complications occurred for 14 patients and only minor ones for the other four. Average post-operative stay was 12 days. For 15 patients, feeding returned to normal throughout the follow-up period. No fistulae were noted and neopharyngeal stenosis occurred in three patients (16 per cent). Thirteen had complete resection with normal margins. Thirteen were still alive after one to three years of follow up. The local recurrence rate was 16 per cent. The use of a pectoralis major myocutaneous flap with Spriano's technique provides a simple, reliable method for circumferential hypopharyngeal resection. It has been applied to a wide range of patients, especially elderly ones and those with poor general status, as well as to cases in which widespread involvement was detected during surgery.

Delayed Pharyngoesophageal Reconstruction with Combined Local and Regional Flaps: A Case Report

“…Actually, regional fl aps such as pectoralis major and deltopectoralis fl aps are generally used when a microsurgical reconstruction is contraindicated or not possible. 9,10,13 Th e present case serves as an example of this situation and reinforces the importance of regional and local fl aps in the reconstructive head and neck surgeon's armamentarium.…”

“…[6][7][8] Myocutaneous fl aps are an alternative for repairing this sort of defect. 9,10 However, in particular situations, such as in a clinically jeopardized patient, the surgeon may be forced to postpone reconstruction in order to minimize the risks of serious complications. In these circumstances, a pharyngostomy and esophagostomy may be performed to minimize operating time, and the fi nal reconstruction can be delayed until a more appropriate occasion.…”

Utility of extended pattern prostate biopsies for tumor localization

“…Regarding pedicled musculocutaneous flaps, whether pectoralis major or latissimus dorsi flaps, their bulkiness often limits tubing and makes them somewhat malleable, particularly in cases of postradiation fibrosis. However, horseshoe‐shaped (or U‐shaped) pectoralis major flaps (i.e., directly sutured to the prevertebral fascia) have been shown to provide good results 11…”

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

“…This latter tool has encountered varied enthusiasm and skepticism, but according to Leó n et al [11] it is at least associated with a reduced occurrence and duration of PCFs, with ensuing shortened postoperative hospital stay, which well counterbalances its cost. Moreover, as underlined by Jegoux et al [13], the presence of a salivary bypass stent may facilitate suturing of the flap around it. Moreover, as underlined by Jegoux et al [13], the presence of a salivary bypass stent may facilitate suturing of the flap around it.…”