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Reconstructive Trends in Post-Ablation Patients with Esophagus and Hypopharynx Defect
Sae Hwi Ki1,2, Jong Hwan Choi2, Seung Hyun Sim3
1Department of Plastic Surgery, Inha University School of Medicine, Incheon, Korea.
Archives of Craniofacial Surgery
|September 16, 2017
Summary
Pharyngoesophageal reconstruction after head and neck cancer surgery requires individualized approaches. Fasciocutaneous and jejunal free flaps offer superior outcomes for complex defects, while pedicled flaps suit high-risk patients.
Area of Science:
- Head and Neck Surgery
- Reconstructive Surgery
- Oncology
Background:
- Pharyngoesophageal reconstruction presents challenges in restoring swallowing and speech.
- Head and neck cancer ablative surgery often necessitates complex reconstructive techniques.
Purpose of the Study:
- To review reconstructive options and complications for pharyngoesophageal defects.
- To evaluate the efficacy of different flap types in head and neck cancer reconstruction.
Main Methods:
- Literature review of PubMed-indexed studies from January 1980 to July 2015.
- Search terms included 'esophagus', 'free flap', 'microsurgical', and 'free tissue transfer'.
- Inclusion criteria focused on pharyngoesophageal reconstruction after head and neck cancer surgery.
Main Results:
- Fasciocutaneous and jejunal free flaps are effective for circumferential defects.
- Pedicled flaps are a safe alternative for high-risk patients or those with fistulas.
- Anterolateral thigh and jejunal free flaps showed better outcomes than radial forearm free flaps.
- Speech function outcomes were reportedly better with fasciocutaneous free flaps compared to jejunal free flaps.
Conclusions:
- Pharyngoesophageal reconstruction must be tailored to individual patient needs and clinical scenarios.
- Free flaps, particularly anterolateral thigh and jejunal, offer robust solutions for complex defects.
- Pedicled flaps remain a viable and safe option in specific patient populations.
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