[Pharyngeal defects and their optimal treatment with musculocutaneous flaps]

A musculocutaneous flap is according to data in the literature and the author's own experience the best solution for covering large defects after extensive operations on the neck. As compared with skin flaps, in particular tubular ones, a musculocutaneous flap has a better vitality and small percentage of complications (necrosis, fistula, stenosis). Its use substantially reduces the postoperative course and period of treatment. In otolaryngological practice it is used most frequently to resolve defects in the laryngooesophageal area. For the reconstruction of the pharynx the authors used mostly the m. pectoralis major. From the technical aspect it is a relatively simple and safe operation and the time for releasing the flap is not excessive. A certain disadvantage after healing is swelling of the neck which is due to the muscular stalk under the skin. It is not only a cosmetic defect as the swelling may make palpation during oncological examination in case of a relapse of the disease impossible. After actinotherapy the muscular stalk may fibrillize.