Hypopharyngeal reconstruction using pectoralis major myocutaneous flap after total hypopharyngolaryngectomy

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Abstract

Introduction: Pharyngoeoesophageal defect after resection of hypopharyngeal carcinoma is usually reconstructed with gastric pull-up or free vascularized flap either jejunum or radial forearm. OBJECTIVE: The aim is to assess the use of pectoralis major myocutaneous flap (PMMCF) sutured directly to the prevertebral fascia for reconstruction of hypopharyngeal defect following total hypopharyngolaryngectomy.
Material and Methods: Total hypopharyngolaryngectomy, total thyroidectomy, partial oesophagectomy and with or without neck dissections were performed for ten patients (seven females and three males) with hypopharyngeal cancer. The defects were reconstructed with PMMCF. The skin island was sutured to the prevertebral fascia.  The main outcome measures included: durations of tube feeding, and hospital stay, character of diet and speech, persistent pharyngocutaneous fistula, recipient and donor site morbidity, tumor recurrence and mortality.
Results: In seven out of ten patients, the duration of hospital stay ranged between 10–42 days while that of nasogastric tube feeding was 20 – 42days. In the 8th patient pharyngotracheal fistula had occurred and failed to heal conservatively, surgical closure was done in association with secondary radical neck dissection. In the 9th patient persistent pharyngocutaneous fistula was reported and the patient was diverted for feeding gastrostomy. She died during the course ofchemoradiotherapy for a recurrent tumor. In the 10th patient the healing attempts were poor and wound dehiscence was occurred and the patient died because of carotid blowout. One patient developed seroma at the donor site.
Conclusion: The use of PMMCF and suturing it to the prevertebral fascia, gives a simple and time-saving method of reconstruction of the pharynx after total hypopharyngolaryngectomy with acceptable results.

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