[Pharynx and cervical esophagus reconstruction with pectoralis major flap]

Among numerous myocutaneous flaps, pectoral major flap is most frequently used in oncological head and neck surgery. It is specially frequent in oral cavity reconstruction, but quite rare in hypopharynx and cervical esophagus reconstruction. Nine patients had squamous cell carcinoma of the oropharynx or hypopharynx with propagation to hypopharynx and/or external larynx. Resection of malignant tumor and defect reconstruction of the pectoral major flap were done in one act. Two patients had the entire oropharynx, hypopharynx, and the cervical part of the esophagus reconstructed, whereas another seven patients had only the hypopharynx and cervical part of the esophagus reconstructed. The pectoral major flap reconstruction was done in three ways: by making a parasternal skin island with tubulous in situ formation (N = 4), with spiral formation of tubulous--Ryan method (N = 1), and by distally making a skin island in the rectangular form and tubulous in situ formation (N = 4). The procedure of flap formation with skin island in the rectangular form was successful, without complications. Much poorer results were achieved with the parasternal skin island formation. The failure rate of the reconstructive surgical procedure was 11.1% (N = 1), using Ryan operative method. Best result were achieved by flap tubulous in situ formation and rectangular skin island creation on the distal part of the muscle.