Fasciocutaneous free flaps for hypopharyngeal reconstruction

Considerable controversy persists regarding the optimal technique for hypopharyngeal reconstruction. The ideal procedure should provide low mortality and morbidity, short hospitalization, a high success rate, few complications, and the greatest potential for neopharyngeal speech and deglutition. In this study, a variety of fasciocutaneous free flaps were used for reconstruction of the hypopharynx. Over a two-year period, fasciocutaneous flaps were used for reconstruction of pharyngoesophageal segments following total laryngopharyngectomies in 16 patients at The National Cancer Institute, Cairo University, Cairo, Egypt. Flap survival, recipient vessels used, and complications were examined. The ultimate functional and cosmetic outcomes of free flaps were compared. Of the 16 patients included in this study, nine were males, and seven were females. Free flaps used for reconstruction included the radial forearm (8), lateral arm (2), anterolateral thigh (3), and posterolateral thigh (3) flaps. Free flaps were successful in 15 patients. One patient had total flap loss. Salvage surgery was successful for one flap that developed venous congestion. Eleven patients received adjuvant radiation therapy. The commonly used recipient vessels were the small arteries of the neck and the external jugular vein. Five patients developed minor pharyngocutaneous fistulas that healed spontaneously. Six patients developed anastomotic line stricture. Donor-site morbidity was more significant with the radial forearm flap, compared to other flaps. Fasciocutaneous free flaps have a definite place in pharyngoesophageal reconstruction. The flap should be selected with reference to the type of the defect and patient obesity; however, donor-site morbidity should also be considered.