Eighteen patients underwent a circumferential pharyngolaryngectomy reconstruction post pharyngolaryngectomy. All tumours showed pharyngo-oesophageal junction invasion or circular involvement of the hypopharynx, requiring total, circumferential pharyngolaryngectomy. A pectoralis major myocutaneous flap was directly sutured to the pre-vertebral fascia. A Montgomery® salivary bypass tube was introduced into the oesophagus, and a nasogastric tube was placed within it. No post-operative complications occurred for 14 patients and only minor ones for the other four. Average post-operative stay was 12 days. For 15 patients, feeding returned to normal throughout the follow-up period. No fistulae were noted and neopharyngeal stenosis occurred in three patients (16 per cent). Thirteen had complete resection with normal margins. Thirteen were still alive after one to three years of follow up. The local recurrence rate was 16 per cent.

The use of a pectoralis major myocutaneous flap with Spriano's technique provides a simple, reliable method for circumferential hypopharyngeal resection. It has been applied to a wide range of patients, especially elderly ones and those with poor general status, as well as to cases in which widespread involvement was detected during surgery.

The risk for post-operative exposure of the carotid artery due to skin flap necrosis after major head and neck surgery is increased after previous radiation and in severely malnourished patients. Eight patients are described who presented with an (imminent) carotid exposure one to eight weeks after surgery. Pectoralis major myofascial flap transfer with split thickness skin graft coverage was used for protection of the carotid artery. All cases were managed successfully and healed primarily in two to four weeks with acceptable cosmesis. We advocate immediate treatment in the event of an exposed carotid (or imminent exposure) by a pectoralis major myofascial flap with split-thickness skin grafting.