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Selecting variants in pharyngeal reconstruction.

J P Shah, L Shemen, R H Spiro

    The Annals of Otology, Rhinology, and Laryngology
    |July 1, 1984
    PubMed
    Summary
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    Pharyngeal reconstruction techniques have evolved with myocutaneous flaps and gastric pull-up operations. Optimal methods depend on defect size, ranging from primary closure to gastric pull-up for extensive pharyngeal defects.

    Area of Science:

    • Head and Neck Surgery
    • Reconstructive Surgery
    • Oncology

    Background:

    • Pharyngeal reconstruction has seen significant advancements in the past decade.
    • The introduction of myocutaneous flaps, microvascular techniques, and the "gastric pull-up" procedure has revolutionized surgical options.

    Purpose of the Study:

    • To review the experience with pharyngeal reconstruction at Memorial Sloan-Kettering Cancer Center between 1974 and 1983.
    • To highlight changing trends in pharyngeal reconstruction philosophy and techniques.

    Main Methods:

    • Review of cases involving pharyngeal resection and reconstruction.
    • Analysis of reconstruction methods including deltopectoral flap, gastric pull-up, free microvascular bowel transfer, and pectoralis myocutaneous flap.
    • Evaluation of indications, morbidity, effectiveness, and complications for each procedure.

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    Main Results:

    • Primary closure is suitable for defects up to one-third of the pharyngeal circumference.
    • Pectoralis myocutaneous flaps are effective for defects up to 70% of the circumference.
    • Gastric pull-up is indicated for defects exceeding 70% and for pharyngoesophageal defects below the tracheostome.

    Conclusions:

    • The choice of pharyngeal reconstruction method is dictated by the extent of the defect.
    • Gastric pull-up and pectoralis myocutaneous flaps represent key advancements in managing large pharyngeal defects.
    • Specific guidelines are established for primary closure, flap reconstruction, and gastric pull-up based on defect size and location.