Reconstructive options for pharyngeal and/or cervical esophageal defects

Reconstruction of the pharynx and or cervical esophagus continues to represent a formidable challenge for the head and neck oncologic surgeon. An analysis was made of 40 patients undergoing pharyngeal and/or esophageal reconstruction. The majority of these reconstructions were sometimes used in combination with skin grafts and even regional skin flaps. Those patients undergoing complete pharyngeal-esophageal reconstruction using a myocutaneous flap with soft Silastic stenting will be discussed as to the potential value of this technique. This article addresses the author's preference for particular reconstructive techniques (ie, skin graft v flap) as it relates to anatomic areas in the pharynx and esophagus. The study concludes that the myocutaneous flaps can be effectively and successfully used for the one-stage reconstruction of subtotal pharyngeal-esophageal defects. However, the reconstruction of total pharyngeal-esophageal defects continues to be a problem area, with only moderate success achieved with the techniques described.