Introduction
Circumferential laryngopharyngectomy and cervical oesophagectomy present
a unique reconstructive challenge due to the complete loss of both the
anterior and posterior pharyngeal walls, requiring mobilisation of
adequate tissue to create the neopharynx. 1-2 The
radial forearm free flap (RFFF), the latissimus dorsi flap, the
anterolateral thigh flap, the free jejunal flap (FJF) and the pectoralis
major myocutaneous flap (PMMC) are more commonly described in the
literature for reconstruction used either tubed or by suturing the flap
in a ‘horseshoe-shaped’ fashion to the prevertebral fascia3-5 In the early surgical series, the use of free
flaps was associated with a higher rate of post-operative fistula
formation (up to 67%) compared to PMMC flap reconstruction (22%)6-7 but the percentage of such complications in the
former groups has significantly improved in more recent studies (11-14%
fistula;14-16% stenosis). 8 However, the biggest
challenge is regarding the long-term functional outcomes of swallow and
speech, which remain poor and difficult to produce good outcomes
consistently.
We describe our experience with the use of a deltopectoral flap for
reconstruction of the posterior pharyngeal wall and another flap
(pectoralis major or supraclavicular flap in our case series) to
complete the reconstruction of the circumferential pharyngo-oesophageal
defects.