Modification of the deltopectoral flap for pharyngoesophageal reconstruction

These modifications minimize flap loss, fistulae, and stenosis, and make the final stage easier to perform. The need for periodic dilation with Maloney dilators may be required; however, we do not consider this a significant complication. The goal is a predictable result with a low complication rate so that oral feedings can begin 5 weeks after laryngopharyngectomy, and postoperative radiotherapy may be started at 6 weeks. The need for three stages may appear excessive; however, three planned stages are better than three or more unplanned stages that result in flap loss or dehiscence.