Use of gastro-omental free flaps in major neck defects

The reconstruction of extensive neck defects with minimum deformity and rapid return to normal food intake is successfully achieved by the use of gastro-omental flaps. We report a series of 18 patients who underwent such reconstructive surgery for major full-thickness defects involving the skin in addition to the larynx and pharynx. Fifteen patients had earlier undergone radiotherapy and 3 chemoradiotherapy; 14 of them had undergone previous surgery. The cause of the defect was tumor recurrence in 10 patients, a pharyngostoma in 6, and postoperative cellulitis in 2.

Harvesting of the flap included elevation of a segment of the greater curvature of the stomach together with the omentum pediculated on the right gastroepiploic vessels. In 8 patients with a circumferential pharyngeal defect, the graft was used in the form of a tube; in the other 10, the graft was converted into a patch to reconstruct the missing anterior pharyngeal wall. In all cases, the omentum was used to fill in the defect. In 5 patients, neck vessels were chosen as recipient vessels, and axillary vessel systems were selected in 13 because the surgical approach to neck vessels was contraindicated.

There was no instance of total flap necrosis. Fifteen patients had an uneventful postoperative course, and oral food intake was begun on the 15th day. The remaining 3 patients developed fistulas, which healed spontaneously. The omentum was left to granulate in all patients, and skin grafts were required in 5 patients only. No abdominal complications occurred in any patients.

These results suggest that gastro-omental free flaps are a method of choice that should be seriously considered for the reconstruction of full-thickness defects of the neck.