下咽颈食段食管环周缺损修复方法的探讨

目的探讨不同手术方法修复重建下咽颈食管环周缺损的适应证，对不同方法的优缺点进行比较。方法对1993年6月至2006年6月期间收治的72例下咽颈食管区肿瘤进行手术切除，并根据肿瘤切除术后缺损的范围，采用胸大肌肌皮瓣、喉管、游离空肠、游离前臂皮瓣和胃上提咽胃吻合5种方法对肿瘤切除术后所致的下咽颈食管环周缺损进行一期修复重建，并重点对所有患者术后的吞咽功能恢复情况进行观察和客观评估。结果胸大肌肌皮瓣修复重建31例，喉管代下咽颈食管8例，游离空肠移植12例，游离前臂皮瓣移植4例，胃上提咽胃吻合术17例。其中15例患者出现了不同程度的并发症，包括创口感染、咽漏、皮瓣部分坏死、胃壁部分坏死和食管吻合口狭窄等，除1例死亡外，其他患者经处理全部治愈。本组患者术后吞咽功能恢复满意，除2例食管吻合口狭窄患者可以进半流食外，其余患者均恢复了正常的进食功能。平均随访时间为1．6年，术后2年生存率为45．3％。结论下咽颈段食管癌切除术后所致的环周缺损可依据缺损的范围和患者的情况选择不同的修复方法，只要适应证掌握得当均可获得满意的修复重建效果。     

303例下咽癌的外科治疗及组织移植修复重建术的临床分析

目的探讨下咽癌的外科治疗及术后下咽食管缺损不同组织移植Ⅰ期重建方法在下咽癌治疗中的远期疗效.方法回顾性分析1965～1998年外科治疗下咽癌患者303例,其中130例经不同组织移植重建下咽食管手术治疗(1997年UICC分期Ⅱ期5例;Ⅲ期16例;Ⅳ期109例),其中梨状窝区94例,咽后壁区18例,环后区18例.游离空肠15例,胃代下咽食管81例,结肠代下咽食管10例,胸大肌肌皮瓣修复20例,其他方法4例.173例下咽癌患者不需要重建(Ⅰ期7例,Ⅱ期12例,Ⅲ期51例,Ⅳ期103例),其中梨状窝160例,咽后壁8例,环后5例.结果 Kaplan-Meire法统计生存率,130例组织移植重建患者3年生存率为43.2%,5年生存率为36.4%;173例不需要组织重建患者3年生存率为59.2%,5年生存率为47.7%.各组吞咽功能良好率均在80%以上.胃代下咽食管手术死亡率为8.6%(7/81例);胸大肌肌皮瓣修复手术死亡率15.0%(3/209例);游离空肠及结肠代食管下咽无手术死亡.总手术并发症20世纪90年代之前为44.3%(35/79例),90年代手术并发症为13.7%(7/51例),χ2=13.457,P=0.004,差异有显著性;其中90年代胸大肌肌皮瓣修复并发症最高为18.2%(2/11例).结论游离空肠、胃代下咽食管、胸大肌肌皮瓣修复在下咽癌的生存率、吞咽功能的恢复及手术并发症等方面均取得较好的治疗效果,是值得提倡的重建方法.     

颈段食管癌手术喉功能保留问题的探讨

目的:探讨颈段食管癌手术喉功能保留的适应证和咽食管重建方法, 以及胃咽吻合术误吸并发症的原因和防治措施.方法:9例保留喉功能的颈段食管癌手术患者,其中单纯颈段食管癌2例,颈段食管癌侵犯下咽部6例,颈胸段食管重复癌1例.喉功能保留:全部喉功能保留8例,部分喉功能保留1例.下咽-食管重建:胃咽吻合7例,游离前臂皮瓣1例, 胸大肌皮瓣1例.结果:喉功能恢复良好4例,中等2例,差3例.胃咽吻合术7例均发生不同程度的胃液反流、咳嗽反射暂时性消失和误吸,5例发生声带麻痹;吻合口越高,误吸程度越重.游离前臂皮瓣移植术1例死于大出血.胸大肌皮瓣转移术1例虽能恢复良好的喉功能,但6个月后发生吻合口狭窄.结论:单纯颈段食管癌和颈段食管癌向上侵犯下咽部1 cm以内的患者适宜行全部喉功能保留手术;而颈段食管癌向上侵犯下咽部部1 cm以上的高龄患者不宜行全部喉功能保留手术,可行部分喉功能保留手术或不保留喉功能手术.胃咽吻合术误吸并发症的发生与咽-食管吞咽功能障碍和喉防误吸功能障碍密切相关.     

咽癌切除术后咽部的重建:两种方法的比较

1977～1987年,作者为117例下咽和口咽癌病人施行了喉咽切除术,咽重建方法分胸大肌肌皮瓣和游离空肠微血管吻合自体移植两种。为便于临床分析,将全部病人分为四组:应用胸大肌肌皮瓣一期重建者12例(第一组),5例成功(42％),7例瘘口形成(58％),其中6例(86％)经挽救手术修复成功;应用游离空肠一期重建者70例(第二组),44例成功(63％),9例失败(13％),其中5例经再次应用游离空肠、1例经胸大肌肌皮瓣挽救成功,17例瘘口形成(24％),其中9例(53     

303例下咽癌的外科治疗及组织移植修复重建术的临床分析

目的探讨下咽癌的外科治疗及术后下咽食管缺损不同组织移植Ⅰ期重建方法在下咽癌治疗中的远期疗效。方法回顾性分析1965～1998年外科治疗下咽癌患者303例，其中130例经不同组织移植重建下咽食管手术治疗(1997年UICC分期：Ⅱ期5例；Ⅲ期16例；Ⅳ期109例)，其中梨状窝区94例，咽后壁区18例，环后区18例。游离空肠15例，胃代下咽食管81例，结肠代下咽食管10例，胸大肌肌皮瓣修复20例，其他方法4例。173例下咽癌患者不需要重建(Ⅰ期7例，Ⅱ期12例，Ⅲ期51例，Ⅳ期103例)，其中梨状窝160例，咽后壁8例，环后5例。结果Kaplan-Meire法统计生存率，130例组织移植重建患者3年生存率为43．2％，5年生存率为36．4％；173例不需要组织重建患者3年生存率为59．2％，5年生存率为47．7％。各组吞咽功能良好率均在80％，以上。胃代下咽食管手术死亡率为8．6％(7／81例)；胸大肌肌皮瓣修复手术死亡率15．0％，(3／209例)；游离空肠及结肠代食管下咽无手术死亡。总手术并发症20世纪90年代之前为44．3％(35／79例)，90年代手术并发症为13．7％(7／51例)，x^2=13．457，P=0．004，差异有显著性；其中90年代胸大肌肌皮瓣修复并发症最高为18．2％(2／11例)。结论游离空肠、胃代下咽食管、胸大肌肌皮瓣修复在下咽癌的生存率、吞咽功能的恢复及手术并发症等方面均取得较好的治疗效果，是值得提倡的重建方法。     

咽胃吻合术中采用近全喉切除保留发音功能－4例报告

为了改善病人的生存质量，作者对４例晚期下咽癌（Ｔ３，Ｔ４）患者行近全喉下咽切除、食管内翻剥脱、咽胃吻合发音重建术。术后给予６０钴放射治疗。手术由气管切开、咽喉切除、胃的游离、食管剥脱并提胃到颈部、胃咽吻合，将术中保留的喉组织制成最大径１．０～１．２ｃｍ发音分路吻合于咽胃吻合的前部。术后随访２年以上，２年生存率７５％（３／４），发音功能好，无明显误吸。术式取材方便、手术简便、并发症少、成功率高。对于晚期下咽癌是一种可行的咽胃吻合发音重建方法。     

头颈部癌游离空肠再建——49例术后并发症与摄食状况

许多报道指出 ,下咽部喉颈部食管摘除后 ,采用游离空肠再建术较带蒂皮瓣再建法并发症少 ,成为现在许多单位标准术式。文章对该术式术后并发症 ,术后咽下关连因素 ,摄食状况与吻合形式关系进行了研究。9年内行咽喉食管摘除游离空肠再建术 4 9例 ,男39例 ,女 10例 ,手术时年龄 4 4～ 78岁 ,平均 6 0 .8岁。原疾患下咽部癌 39例最多 ,其次颈部食管癌 4例 ,喉癌 3例 ,甲状腺癌 2例 ,气管癌 1例。手术单独行游离空肠再建 4 5例 ,其中侧端吻合 2 2例 ,头端吻合 18例ρ”形吻合 4例 ,修补吻合 1例。另游离空肠和胃管并用 4例。术后观察时间最长 10 …     

晚期下咽癌、喉复发癌术后颈部缺损整复组织的选择

目的:探讨以不同组织移植物Ⅰ期重建晚期下咽癌、喉复发癌术后颈部、下咽食管缺损的适应证及治疗效果。方法:喉复发癌36例, 肿瘤切除后采用胸大肌肌皮 瓣修补组织缺损18例,肩胸皮瓣修补4例,胃代食管修补2例,胸部推移皮瓣重建下颈部与上纵隔组织缺损,并消灭手术死腔12例。晚期下咽癌16例,颈段食管癌8例,以游离空肠整复1例, 健侧喉黏膜瓣修复咽部缺损8例,喉气管代食道8例,胸大肌皮瓣修复咽部缺损2例,胃代食管2例,游离前臂皮瓣修复下咽1例。 结果:术中无一例死亡,术后无修复组织坏死 ,全部组织瓣存活。采用健侧喉黏膜瓣修复者,仅 1例有术前放疗史的患者发生术后咽漏,胸大肌皮瓣 修复者发生咽漏1例,胃代食道术后发生咽漏1例。全部病例愈合后均恢复正常饮食。随访 9～84个月,14例出现吞咽梗阻,可进流质饮食。结论:下咽癌患者术后组织缺损的修复方法各有侧重。肿瘤的部位和手术后组织缺损的大小是选择修复方法的首要因素;其次,应结合患者的年龄和全身状况,考虑减少并发症。     

胃上提结肠上徙在下咽食管病变切除后缺损修复中的应用

目的:探讨下咽、食管肿瘤及狭窄病变切除后,采用胃上提结肠上徙进行食管重建的手术适应证和术后并发症。方法:回顾性分析行胃上提咽胃吻合52例、结肠上徙咽结肠吻合66例患者的临床资料,其中肿瘤组87例,行胃上提52例,结肠上徙35例;下咽食管腐蚀性狭窄和闭锁组31例,均行结肠上徙食管重建。结果:肿瘤组胃上提52例中保留喉功能28例;结肠上徙35例中保留喉功能18例,选择不同的食管修复方法对喉功能保留无明显影响(P>0.05)。但结肠上徙组咽瘘发生率25.8%(17/66)明显高于胃上提组9.6%(5/52)(P<0.05)。胃上提组胃液反流发生率30.8%(16/52)明显高于结肠上徙组4.5%(3/66)(P<0.05)。结论:胃上提结肠上徙食管修复术可以在彻底切除下咽、颈段食管肿瘤的同时,保留部分患者的喉功能。由于胃上提患者术后胃液反流的发生率较高,且吻合口位置较高,对保留喉功能的下咽或食管肿瘤临床上仍主张采用结肠上徙修复。但由于结肠血液供应不如胃组织丰富,咽-肠吻合口瘘的发生率较高。     

自体游离空肠重建喉咽及颈段食管

目的探讨自体游离空肠移植重建喉咽及颈段食管的临床应用。方法回顾性研究1999年8月～2006年8月共进行的9例喉咽和(或)颈段食管肿瘤切除、自体游离空肠移植食管和(或)喉咽重建术病例。总结手术适应证的选择、手术方法、围手术处理方法及手术效果。结果9例患者移植游离空肠全部存活,无咽瘘、颈部感染或吻合口狭窄等颈部并发症。2例成功保留喉功能。9例患者最长随访时间37个月,最短22个月。1例患者术后22个月时发现舌根部肿瘤复发,经放射治疗后好转,术后25个月失访。1例患者术后17个月因肿瘤复发死亡。其余7例存活,无吞咽困难,未见肿瘤复发。结论正确的适应证选择,合理的围手术期处理,以及熟练的小血管吻合技术是游离空肠移植重建喉咽和颈段食管,治疗晚期喉咽癌、颈段食管癌成功的保证;再次证明,游离空肠移植重建喉咽和颈段食管不仅为肿瘤完全切除并一期重建提供技术保障,还能提高患者的无瘤生存率和生存质量。     

下咽环周缺损重建方法的选择

OBJECTIVE: To choose the optimal reconstruction for circumferential defects of the hypopharynx between pharyngogastric anastomosis and free jejunal interposition is. METHODS: Retrospective review of the archives of 125 patients who underwent pharyngoesophageal reconstruction with pharyngogastric anastomosis(n = 92) or free jejunal interposition(n = 33). Analysis was confined to patient with advanced hypopharyngeal cancer or recurrent laryngeal cancer who had hypopharyngeal circumferential defects after tumor ablation. RESULTS: The morbidity and mortality associated with reconstructive procedures were significantly higher in the pharyngogastric anastomosis group than in the free jejunal interposition group (43% versus 21%, P = 0.023 and 11% versus 0%, P = 0. 048). The risk factors related to complications associated with the procedures were reconstruction with pharyngogastric anastomosis (OR 2.97; 95% CI 1.14; 7.76) and albumin < 40.0 g/L(OR 2.87; 95% CI 1.33; 6.16) . The occurrence of swallow obstruction or regurgitation was higher in the pharyngogastric anastomosis group than in the free jejunal interposition group(76% versus 12%, P = 0.00). Patients in the pharyngogastric anastomosis group had lost weight of 3.3 kg (95% CI - 5.7; - 1.0) postoperatively, on the contrary, patients in the free jejunal interposition group had gained weight of 2.8 kg(95% CI 0.9; 4.7) postoperatively. CONCLUSION: Patients reconstructed with free jejunal interposition had lower mortality and complications than with pharyngogastric anastomosis. Furthermore, the former seems to have better quality of life than the latter. The first choice of reconstructive strategy for hypopharyngeal circumferential defects is free jejunal interposition.     

游离空肠移植重建下咽及颈段食管112例临床分析

目的 探讨游离空肠修复下咽及颈段食管肿瘤切除术后组织缺损的方法及疗效.方法 回顾性分析1984年10月至2009年10月中国医学科学院肿瘤医院头颈外科112例下咽、颈段食管癌及喉癌复发患者肿瘤切除术后所致下咽环周及颈段食管缺损以游离空肠进行Ⅰ期修复的临床资料.结果 112例患者中,游离空肠坏死6例,游离空肠移植成功率94.6%(106/112);吻合口瘘发生率、吻合口狭窄率分别为8.9%(10/112)、12.5%(12/96);围手术期死亡率1.8%(2/112).除1例围手术期死亡、6例空肠坏死和2例保留喉患者未恢复经口进食外,其余103例患者在术后平均12 d恢复经口进食.结论 游离空肠移植手术成功率高,手术并发症及围手术期死亡率低,吞咽功能恢复快.对颈动脉未受侵,能保证手术安全切缘的患者,建议首选游离空肠修复.

Abstract：

Objective To investigate the results of reconstruction of hypopharyngeai circumferential and cervical esophageal defects with free jejunal transfer. Methods Retrosepective review of 112 patients who underwent pharyngoesophageal reconstruction with free jejunal interposition. Analysis was confined to the patients with advanced hypopharyngeal, esophageal or recurrent laryngeal squamous cell cancer. Kaplan-Meier method was used to identify the accumulative survival rate. Results The free jejunal success rate was 94. 6% ( 106/112). The pharyngocutaneous fistula rate and anastomoses narrow rate were 8. 9% ( 10/112) and 12. 5% ( 12/96) respectively. The perioperative mortality rate was 1. 8% (2/112). Except 1 case of dead, 6 cases with flap failure and 2 cases with laryngeal preservation, other 103 cases had resumed oral feeding. Conclusions The success rate of free jejunal transplation is high and free jejunal interposition is an ideal reconstruction method for patients who have hypopharyngeai circumferential and cervical esophageal defects after tumor resection.     

喉全切除后气管造瘘口复发癌缺损外科修复比较

目的探索喉全切除后气管造瘘口复发癌缺损外科修复的治疗效果。方法对18例喉全切除后气管造瘘口复发癌实施外科治疗。其中Ⅰ型7例,颈部单纯切口,胸大肌肌皮瓣修复颈部皮肤气管造瘘口缺损;Ⅱ型6例,颈肢或胸联合切口,前臂皮瓣或胸大肌肌皮瓣(游离前臂皮瓣5例,胸大肌肌皮瓣1例)修复部分喉咽切除;Ⅲ型3例,颈腹联合切口,游离空肠修复全喉咽、颈段食管;Ⅳ型2例,颈胸腹联合切口,胃上拉修复全喉咽、全食管。Ⅱ、Ⅲ、Ⅳ型的颈部皮肤气管造瘘口缺损均用胸大肌肌皮瓣修复。结果颈部缺损胸大肌肌皮瓣均成活;咽瘘4例(其中游离空肠1例,前臂皮瓣2例,胃上拉咽瘘出血1例);全部病例术后均能进食;随访6～74个月,3例出现不同程度吞咽梗阻。结论喉全切除后气管造瘘口复发癌外科治疗缺损,修复选择应根据原发肿瘤治疗的经过及气管造瘘口复发癌侵及范围来确定修复方法。     

Functional outcomes after circumferential pharyngoesophageal reconstruction

OBJECTIVE: To determine functional speech and swallowing outcomes, morbidity, and complication rates after reconstruction of circumferential pharyngoesophageal defects using a jejunal versus an anterolateral thigh (ALT) flap. STUDY DESIGN: Retrospective analysis. METHODS: We reviewed the medical records of 58 patients with circumferential pharyngoesophageal defects, 27 with ALT flap reconstruction, and 31 with jejunal interposition. We compared complication rates, intensive care unit (ICU) and hospital stays, nutritional intake, number of tracheoesophageal punctures (TEPs) performed, TE speech fluency, and functional use. Modified barium swallow studies assessed swallowing physiology. RESULTS: Patient characteristics were similar. Total flap loss occurred in one (3.7%) patient with an ALT flap and two (6.5%) patients with jejunal interposition (P = 1.000), fistula in two (7.4%) ALT patients and one (3.2%) jejunal patient (P = .5931), and anastomotic stricture in four (15%) ALT patients and six (19.4%) jejunal patients (P = .7371). ICU and hospital stays were greater for jejunal patients (P = .001, <.001, respectively). TEPs were performed in eight jejunal patients and nine ALT patients. Eighty-nine percent of ALT patients and 63% of jejunal patients were fluent, whereas 78% of ALT patients and 25% of jejunal patients used TE speech to communicate. Ninety-one percent of ALT patients and 73% of jejunal patients resumed oral intake (P = .151). The most common causes of dysphagia were impaired tongue base retraction (62% jejunum) and disordered motility (62% jejunum, 67% ALT). CONCLUSIONS: For circumferential pharyngoesophageal reconstruction, the ALT flap results in similar complication rates, but shorter ICU and hospital stays, and better speech and swallowing compared with jejunal reconstruction.     

Reconstruction of hypopharyngeal defects with anterolateral thigh free flap: A single-center retrospective analysis

IntroductionReconstruction of expanded hypopharyngeal defects following laryngo-hypopharyngectomy for surgical treatment of primary is still a challenge for head and neck surgeons. Tradiotionally, jejunal or radial forearm flaps are the common reconstructive choice. Recently, the anterolateral thigh (ALT) free flap has served for pharyngoesophageal reconstruction. The goal of this work is to describe a retrospective analysis about a five-year single-center experience in the reconstruction of post-operative hypopharyngeal defects with ALT free flap.MethodsA single-center retrospective study was performed, including patients treated for patients who underwent tumor surgery involving hypopharynx with ALT free flap reconstruction from 2015 to 2020. Exclusion criteria were paediatric (0–18 years) patients, and the absence of follow-up.ResultsThe study included 23 adult patients. The mean size of the flap was 90 cm² (range 60–130 cm²). The mean time required to harvest the antero-lateral tight flap was 70 min (range 35–120 min). The median age was 46.3 years (SD 15.81, range: 19–84 years), with a gender female prevalence (F = 48, M = 33). Mean follow-up was 77.7 months (min 4–max 361, SD 72.46). One patient (4.4 %) showed a hypopharyngeal stenosis.ConclusionALT free flap represents a successful and versatile reconstructive option for hypopharyngeal defects extended to oropharynx and/or larynx following total laryngectomy with circumferential or partial hypopharyngectomy, regardless of the functional and aesthetic results, with minimal donor-site complication.     

The reconstruction of upper alimentary tract after resection of hypopharyngeal and cervical esophageal cancer]

The most difficult problem during surgical treatment in the hypopharyngeal and cervical esophageal cancer is the reconstruction of upper alimentary tract after resection of the lesions. From April 1984 to October 1990, 52 patients of hypopharyngeal and cervical esophageal cancer were treated by surgery (39 men and 13 women). The age ranged 43-73 years. All of the cases were squamous cell carcinoma except one adenocarcinoma. The pectoralis major myocutaneous flap (PMF) was used in 32 patients, total gastric transposition (GT) in 15 patients, free jejunal interposition (FJI) in 3 patients and free forearm flap (FFF) in 2 patients. Results showed that satisfactory and lasting deglutatory function was achieved in 48 of 52 patients (92.3%). One and three-year survival rates were 86.2% and 65% respectively. These data showed that reconstructive method described above are effective and reliable.     

Oncological outcome after free jejunal flap reconstruction for carcinoma of the hypopharynx

It has been a common practice among the oncologist to reduce the dosage of adjuvant radiotherapy for patients after free jejunal flap reconstruction. The current aims to study potential risk of radiation to the visceral flap and the subsequent oncological outcome. Between 1996 and 2010, consecutive patients with carcinoma of the hypopharynx requiring laryngectomy, circumferential pharyngectomy and post-operative irradiation were recruited. Ninety-six patients were recruited. TNM tumor staging at presentation was: stage II (40.6%), stage III (34.4%) and stage IV (25.0%). Median follow-up period after surgery was 68?months. After tumor ablation, reconstruction was performed using free jejunal flap (60.4%), pectoralis major myocutaneous (PM) flap (31.3%) and free anterolateral thigh (ALT) flap (8.3%). All patients underwent adjuvant radiotherapy within 6.4?weeks after surgery. The mean total dose of radiation given to those receiving cutaneous and jejunal flap reconstruction was 62.2?Gy and 54.8?Gy, respectively. There was no secondary ischaemia or necrosis of the flaps after radiotherapy. The 5-year actuarial loco-regional tumor control for the cutaneous flap and jejunal flap group was: stage II (61 vs. 69%, p?=?0.9), stage III (36 vs. 46%, p?=?0.2) and stage IV (32 vs. 14%, p?=?0.04), respectively. Reduction of radiation dosage in free jejunal group adversely affects the oncological control in stage IV hypopharyngeal carcinoma. In such circumstances, tubed cutaneous flaps are the preferred reconstructive option, so that full-dose radiotherapy can be given.     

Laparoscopic harvest of the jejunal free flap for reconstruction of hypopharyngeal and cervical esophageal defects

BACKGROUND: Reconstruction of hypopharyngeal and cervical esophageal defects remains one of the greatest challenges to head and neck and reconstructive surgeons. Although the jejunal free flap is a well-known reconstructive choice, many authors prefer alternative methods because of the complication rates and donor site morbidity associated with traditional jejunal flap harvest. Laparoscopic resection of the small intestine is a well-documented surgical technique. However, laparoscopic harvest of a jejunal segment for use in free tissue transfer reconstruction of defects of the hypopharynx and cervical esophagus has primarily been described in animal models, with only a few clinical studies existent in the recent literature. OBJECTIVE: To evaluate the use of a laparoscopic technique for harvesting jejunal segments for use in free tissue transfer reconstruction of pharyngoesophageal defects. PATIENTS AND METHODS: The records of 12 patients who underwent laparoscopic jejunal flap harvest for reconstruction of large hypopharyngeal or cervical esophageal defects at the University of Washington, Seattle, from January 1998 through April 2001 were retrospectively reviewed. Time of harvest, need to convert to "open" technique, failure rate, complications, and length of hospital stay were evaluated. RESULTS: All harvests were completed laparoscopically. The average operative time for the abdominal portion of the procedure was 2.4 hours. Warm ischemia time required for flap removal from the peritoneal cavity was less than 4 minutes. Each patient received a completely endoscopic jejunum harvest, bowel reanastomosis, and placement of a feeding jejunostomy tube. Enteral feedings began on the first postoperative day. No major complications were seen resulting from this technique, and no donor site morbidity was identified. All flaps were viable, with no revisions required. Activity in hospital and time to discharge were independent of the abdominal procedure. CONCLUSION: Given the low complication rate and relative ease of harvest, we conclude that this new technique is currently the best way to harvest jejunal flaps for reconstructing these challenging defects and should renew enthusiasm for this versatile flap.     

Modification of fasciocutaneous radial forearm free flap to achieve two-layer closure during reconstruction of circumferential hypopharyngeal defects

Circumferential defects of the hypopharynx are a reconstructive challenge. Various local, regional and free flaps have been described with each having advantages and disadvantages in terms of functional outcomes. The fasciocutaneous radial forearm free flap (RFFF) is one of the most common free flaps used for reconstructing circumferential hypopharyngeal defects. The skin paddle is pliable and reasonably matches the native hypopharyngeal wall. It is easy to raise, has predictable vascular anatomy and a long pedicle. Unlike the anterior lateral thigh (ALT) flap, the RFFF is associated with higher rates of pharyngo-cutaneous fistula. This was thought to be due to the difficulty in achieving two-layer closure. However, in a post treatment neck or in patient with large body habitus, the use of ALT or other free flaps may not be possible leaving the RFFF as the only viable option. To aim to reduce the risk of fistula and wound dehiscence, we describe a novel design of RFFF, which provides two-layer closure. We believe that our design gives the reconstructive surgeon another reconstructive option, which should be considered in challenging circumferential hypopharyngeal defects.