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Results of reconstruction with free forearm flap following laryngopharyngo-oesophageal resection

Published online by Cambridge University Press:  29 June 2007

Istemihan Akin ,
Ahmet Torkut ,
Engin Ustünsoy ,
Gürkan TaŞkoparan  and
Ata Gürzumar
Istemihan Akin*
Affiliation:
1st Ear, Nose and Throat Surgery Clinic, Social Security Association Ankara Hospital, Ankara, Turkey
Ahmet Torkut
Affiliation:
Plastic and Reconstructive Surgery Clinic, Social Security Association Ankara Hospital, Ankara, Turkey
Engin Ustünsoy
Affiliation:
Plastic and Reconstructive Surgery Clinic, Social Security Association Ankara Hospital, Ankara, Turkey
Gürkan TaŞkoparan
Affiliation:
1st Ear, Nose and Throat Surgery Clinic, Social Security Association Ankara Hospital, Ankara, Turkey
Ata Gürzumar
Affiliation:
1st Ear, Nose and Throat Surgery Clinic, Social Security Association Ankara Hospital, Ankara, Turkey
*
Address for correspondence: Dr Istemihan Akin, Koza Sokak, 42/53, Gaziosmanpaşa - 06700, Ankara, Turkey.
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Abstract

The main challenge after total laryngopharyngeal and cervical oesophageal resection for laryngopharyngeal carcinoma, is to provide a suitable feeding conduit which improves the quality of life for the patient. Reconstruction with a tubed free forearm flap can solve the feeding problem to some extent, providing a thin and pliable fasciocutaneous conduit that accommodates well with the thin mucosa of the pharynx and oesophagus.

In this study immediate reconstruction of the pharyngo-oesophagus by free forearm flaps is reported in nine patients with advanced laryngopharyngeal and oropharyngeal carcinoma. The vascularization of the flap is very good, thus rendering this flap to be reliable. The average time for the commencement of oral feeding was 16 days. There was one flap failure (11 per cent), due to venous thrombosis which was replaced by a deltopectoral flap. Long term stenosis did not occur because of the two triangles created at the distal end of the flap which were inserted to the opposite triangular defects at the proximal oesophageal stump.

Donor site morbidities were minimal and scarring of the forearm was acceptable for all the patients.

Keywords

Hypopharyngeal neoplasmsSurgical flaps
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 111 , Issue 1 , January 1997 , pp. 48 - 53
Copyright
Copyright © JLO (1984) Limited 1997

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References

Akin, I., Senel, Y., Torkut, A., Üstünsoy, E., Gürzümar, A. (1994) Hypopharyngeal and cervical esophageal reconstruction with free forearm flap. Journal of Ankara Medical School 16, 3: 3–1069.Google Scholar
American Joint Committee on Cancer. (1987) Manual for Staging of Cancer. 3rd Edition, J.B. Lippincott, Philadelphia.Google Scholar
Ariyan, S. (1979) The pectoralis major myocutaneous flap: A versatile flap for reconstruction in the head and neck. Plastic and Reconstructive Surgery 63: 73–81.Google Scholar
Bakamjian, V. Y. (1965) A two-stage method for pharyngoesophageal reconstruction with a primary pectoral skin flap. Plastic and Reconstructive Surgery 36: 173–184.Google Scholar
Carpenter, R. J. III, DeSanto, L. W., Devine, K. D. (1979) Reconstruction after total laryngopharyngectomy. Archives of Otolaryngology 105: 417–422.CrossRefGoogle ScholarPubMed
Delaere, P. R., Boeckx, W. D., Ostyn, F., Tyberghein, J., Guelinckx, P. J. (1988) Hypopharyngeal stenosis and fistulas. Achives of Otolaryngology, Head and Neck Surgery 114: 1326–1329.Google Scholar
Evans, H. B., Lampe, H. B. (1987) The radial forearm flap in head and neck reconstruction. Journal of Otolaryngology 16: 382–386.Google ScholarPubMed
Fisher, S. R., Cole, T. B., Meyers, W. C., Seigler, H. F. (1985) Pharyngoesophageal reconstruction using free jejunal interposition grafts. Archives of Otolaryngology 111: 747–752.Google Scholar
Flynn, M. B., Banis, J., Acland, R. (1989) Reconstruction with free bowel autografts after pharyngoesophageal or laryngopharyngoesophageal resection. American Journal of Surgery 158: 333–336.CrossRefGoogle ScholarPubMed
Gilas, T., Sako, K., Razack, M. S., Bakamjian, V. Y., Shedd, D. P., Calamel, P. M. (1986) Major head and neck reconstruction using the deltopectoral flap: A 20 year experience. American Journal of Surgery 152: 430–434.Google Scholar
Gluckman, J. L., McDonough, J. J., McCafferty, G. J., Black, R. J., Coman, W. B., Cooney, T. C., Bird, R. J., Robinson, D. W. (1985) Complications associated with free jejunal graft reconstruction of the pharyngoesophagus-a multiinstitutional experience with 52 cases. Head and Neck Surgery 7: 200–205.Google Scholar
Harii, K., Ebihara, S., Ono, I., Saito, H., Terui, S., Takato, T. (1985) Pharyngoesophageal reconstruction using a fabricated forearm free flap. Plastic and Reconstructive Surgery 75: 463–474.Google Scholar
Harrison, D. F. N. (1991) Replacement of cervical esophagus by gastric transposition. In Laryngeal Cancer (Silver, C. E., ed.), Thieme Medical Publishers, Inc., New York, pp 260–267.Google Scholar
McConnel, F. M. S., Hester, T. R. Jr., Nahai, F., Jurkiewicz, M. J., Brown, R. G. (1981) Free jejunal grafts for reconstruction of pharynx and cervical esophagus. Archives of Otolaryngology 107: 476–481.CrossRefGoogle ScholarPubMed
Pech, A., Cannoni, M., Zanaret, M., Collignon, G., Thomassin, J. M., Goubert, J. L., Fuchs, S. (1984) Total circular pharyngo-laryngectomy: method of reconstruction by a free forearm skin flap (Summary in English). Annals of OtoLaryngology (Paris) 101: 535–540.Google Scholar
Rees, R. S., Ivey, G. L. III, Shack, R. B., Franklin, J. D., Lynch, J. B. (1986) Pectoralis major musculocutaneous flaps: Long-term follow-up of hypopharyngeal reconstruction. Plastic and Reconstructive Surgery 77: 586–590.CrossRefGoogle ScholarPubMed
Schuller, D. E. (1985) Reconstructive options for pharyngeal and/or cervical esophageal defects. Archives of Otolaryngology 111: 193–197.Google Scholar
Seidenberg, B., Rosenak, S. S., Hurwitt, E. S., Som, M. L. (1959) Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment. Annals of Surgery 149: 162–171.Google Scholar
Shangold, L. M., Urken, M. L., Lawson, W. (1991) Jejunal transplantation for pharyngoesophageal reconstruction. Otolaryngologic Clinics of North America 24: 1321–1342.CrossRefGoogle ScholarPubMed
Shaw, H. J. (1976) Pharyngolaryngo-oesophagectomy. In Operative Surgery. Butterworth & Co. Ltd., London, pp 211–218.Google Scholar
Song, R., Gao, Y., Song, Y., Yu, Y., Song, Y. (1982) The forearm flap. Clinics of Plastic Surgery 9, 1: 1–21.Google Scholar
Takato, T., Harii, K., Ebihara, S., Ono, I., Yoshizumi, T., Nakatsuka, T. (1987) Oral and pharyngeal reconstruction using the free forearm flap. Archives of Otolaryngology, Head and Neck Surgery 113: 873–879.Google Scholar