Reconstruction of pharyngostomes with a modified deltopectoral flap combining endoscopy and tissue expansion

The problem of pharyngostomic closure is difficult to solve, as evidenced by the large number of techniques described. The authors present the reconstruction of pharyngostomes by using Bakamjian's deltopectoral flap modified by the use of endoscopically introduced expanders for those patients in whom other techniques of choice (such as vascularized free flaps) have failed or are inapplicable either because of previous radiotherapy or because of local conditions. Bakamjian's deltopectoral flap, previously expanded with an expander coated with a partial-thickness skin graft and introduced endoscopically, allowed the authors to lift the flap in one operation to close the pharyngostome. This method provides the two walls of the pharynx (the skin graft as the inner aspect and the skin flap as the outer aspect), and the donor deltopectoral area is covered and epithelialized due to the skin graft. Thus by means of endoscopic expansion we use a nonaggressive technique to increase the surface area of the donor site and to increase its vascularization (delay phenomenon). Because the expander was coated with the graft, the authors were able to cover the anterior wall of the pharyngostome and the donor site in one surgical step.