One-Stage Reconstruction of Partial Laryngopharyngeal Defects

• Published in: The Laryngoscope 1997-02, Vol.107 (2), p.247-253
• Main Authors: Schuller, David E., Mountain, Rodney E., Nicholson, Roy E., Bier-Laning, Carol M., Powers, Bret, Repasky, Michael
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Carcinoma, Squamous Cell - surgery; Female; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Humans; Hypopharynx; Laryngeal Neoplasms - surgery; Laryngopharyngeal defect; Larynx; Length of Stay; Male; Medical sciences; Middle Aged; Oropharyngeal Neoplasms - surgery; Postoperative Complications; Reconstruction techniques; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the upper aerodigestive tract; Surgical Flaps; Treatment Outcome
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1097/00005537-199702000-00019

Advanced‐stage lesions of the hypopharynx or tongue base often involve the larynx. The difficulty of reconstructing large partial laryngopharyngeal defects can result in total laryngectomy being performed to avoid the assumed problems with aspiration. This article describes the first reported experience using the pectoralis musculocutaneous flap for primary one‐stage reconstruction of laryngopharyngeal defects following resection of advanced‐stage lesions, to reconstruct both the laryngeal and the pharyngeal components of the defect. In this group of 21 patients, there were 16 with hypopharyngeal and 5 with tongue base cancers. Two had received prior treatment, and all received some form of postoperative radiotherapy and/or chemotherapy. Six patients experienced complications, including two fistulae, three wound infections, two myocardial infarctions, and one colon perforation. There were no instances of stenosis of the reconstructed segment. The length of hospitalization ranged from 9 to 60 days, the average being 17 days. Forty‐seven percent (21) of the patients were not tolerating an oral diet at the time of discharge. However, 15 patients (71%) ultimately were eating by mouth, with 13 (62%) achieving an oral intake of liquids and solids. This analysis supports the hypothesis that the pectoralis major musculocutaneous flap is an effective one‐stage primary reconstruction technique for laryngopharyngeal defects in patients either who have received prior therapy or who will receive postoperative therapy.