Technique of neo-pharynx reconstruction with supra-clavicular artery island flap in a case of pharyngeal stricture

Abstract

<p class="abstract">Pharyngeal stenosis frequently occurs after laryngectomy or laryngo-pharyngectomy, more commonly in patients complicated with a post-operative pharyngo-cutaneous fistula. Oral feeding becomes challenging, restricted to liquids. In such cases, dilatations can be futile if there is a complete stricture necessiating surgery. We present a case of 72 -year-old man who underwent total laryngectomy with partial pharyngectomy with pectoral major myocutaneous flap reconstruction for second primary of hypopharyngeal T3N0M0, after primary laryngeal T1N0M0 treated with RT presented with nearly 4 cm pharyngeal stricture causing him absolute dysphagia. Multiple dilations failed to create adequate passage, pharyngeal stricture was then excised, and a neopharynx was constructed with supraclavicular artery island flap. The outcome was uneventful with restoration of normal pharyngeal permeability and swallowing by 12<sup>th</sup> post-operative day. Post-operative follow-up after 8 months remained satisfactory. Resection of limited height pharyngeal stenosis can be successfully performed as end-to-end anastomosis whereas reconstruction of a long segment pharyngeal stricture utilizing a loco-regional flap gives satisfactory outcome.</p>

Postlaryngectomy pharyngoplasty with melolabial flap

“…The use of a vascularised flap during pharyngoplasty can help to reduce these problems. The locoregional flaps such as the pectoralis major myocutaneous flap, deltopectoral flap or supraclavicular artery-based island flap, distant flaps such as the radial artery forearm free flap or anterolateral thigh free flap and gastric pull up or free jejunal flap (for circumferential defects) are options 3 5 15–17. All of those flaps’ advantages and shortcomings have already been described in various publications3 18–22 (table 3).…”