[Total circular pharyngolaryngectomy. A method of reconstruction with a free forearm skin flap]

The reconstruction of the digestive tube after total circular pharyngo-laryngectomy continues to pose a number of problems. Fistulae and delayed healing of the mucosa are common problems after musculo-cutaneous flaps. They are due, on the one hand, to a spring effect of the flap which interferes with tubulisation and, on the other hand, to the problematical suture of the thick thoracic wall skin to the fine oesophageal mucosa. Free visceral plasties give first intention repairs with rapid return of eating, but they carry a mortality of 10 to 15%. The free ante-brachial plasty with a radial pedicle seems to be a satisfactory alternative due to the quality of the oesophageal reconstruction and the absence of mortality. The technique of forming the flap and the operative procedure are described. Five cases are presented. There were no failures and oral feeding could be re-commenced by the 21st day, on average.