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Published on: February 10, 2020
Reconstruction of circumferential pharyngeal defects after tumour resection: reference or preference
Yu Wai Chan1, Raymond Wai Man Ng, Lawrence Hin Lun Liu
1Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China. chanjyw@gmail.com
Summary
Free jejunal flaps offer superior functional outcomes for hypopharyngeal defect reconstruction after circumferential pharyngectomy. This method minimizes complications and improves the ability to resume a solid diet.
Area of Science:
- Otolaryngology
- Head and Neck Surgery
- Surgical Oncology
Background:
- Reconstruction of circumferential hypopharyngeal defects presents significant surgical challenges.
- Developing improved management guidelines is crucial for better patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of different flap options for circumferential pharyngectomy reconstruction.
- To analyze functional outcomes and complication rates associated with various reconstructive techniques.
Main Methods:
- A retrospective analysis of 202 patients undergoing circumferential pharyngectomy between 1980 and 2009.
- Comparison of pectoralis major (PM) flap, free anterolateral thigh (ALT) flap, and free jejunal flap reconstruction.
- Prospective data recording on fistula rates, anastomotic strictures, functional diet, and donor-site morbidity.
Main Results:
- Free jejunal flap demonstrated the lowest early fistula (4.6%) and late anastomotic stricture (2.3%) rates.
- Patients reconstructed with free jejunal flaps had a higher rate of resuming a solid diet (61.9%) compared to PM (35.8%) and ALT (38.1%) flaps.
- Pectoralis major flap harvesting led to significant chest wall defects in 34.8% of cases, while ALT and jejunal flaps had low donor-site morbidity.
Conclusions:
- Free jejunal flap reconstruction is the preferred method for circumferential pharyngectomy defects in suitable patients.
- This technique offers the best functional recovery and minimal donor-site morbidity.
- Early fistula formation is a significant risk factor for subsequent anastomotic stricture.