Reconstruction of the hypopharynx with U-shaped pectoralis major myocutaneous flap after total pharyngo-laryngectomy

Abstract

Resection of the whole circumference of the pharynx and esophagus is usually reconstructed with gastric pull-up, jejunum free graft or free forearm flap. The aim of this study was to assess the use of pectoralis major myocutaneous flap for closure of total pharyngeal defect. In 11 patients with hypopharynx and larynx cancer, total pharyngo-laryngectomy and excision of the cervical part of the esophagus and neck dissections were performed; the defects were closed with pectoralis major myocutaneous flaps. The skin island was sutured to prevertebral muscles, forming a letter U shape. Good healing was obtained in six patients, and five patients developed fistula that closed spontaneously within 3-4 weeks. The use of U-shaped pectoralis major myocutaneous flap, suturing it to prevertebral muscles, gives good functional results, and it is a simple and time-saving second choice method of reconstruction of the pharynx after total pharyngo-laryngectomy.

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

“…12,14,25 For the 'horseshoe-shaped' pectoralis major flap procedure, operative time is short and no specific microvascular experience is required. A skin graft on the posterior wall was used by Fabian, 26 Lee and Lore 27 and Leon et al, 28 but not by Spriano et al 2 or Morshed et al 29 A Montgomery salivary bypass tube was used by all except Morshed. The method, as developed by Spriano et al, 2 is based on a procedure described by Fabian 20 in 1984 involving the addition of a skin graft to pre-vertebral fascia.…”

Fasciocutaneous free flaps for reconstruction of hypopharyngeal defects

“…Currently, fasciocutaneous free flaps, in particular radial forearm (RF) and anterolateral thigh (ALT), are considered among the main options for such a reconstructive purpose, especially considering the high rates of PCF and stenosis generally observed after pectoralis major myocutaneous (PMMC) pedicled flap, and the non‐negligible complication rate associated with a jejunum free flap …”

Evaluation of Cases who Underwent Reconstruction Through Pectoralis Major Myocutaneous Flap After Laryngopharyngectomy

“…After the first report of Fabian (7), notifications were provided in smallsized series by 4 researchers (6,(8)(9)(10). A skin graft on the posterior wall was used by Fabian (7), Lee et al (8), and Leon et al (9) but was not used by Spriano et al (6) and Morshed et al (10).…”