title: Free gastro-omental flap reconstruction of the complex, irradiated pharyngeal wound.
abstract: BACKGROUND
  Reconstruction of the complex pharyngeal wound after radiotherapy presents a surgical challenge.
  
  
  METHODS
  Evaluation of the gastro-omental flap in the reconstruction of the pharynx and overlying soft tissue after local flap failure.
  
  
  RESULTS
  A 70-year-old patient underwent a total laryngectomy and radical neck dissection after 70 Gy of external beam radiotherapy for an advanced squamous cell carcinoma of the pyriform sinus. Postoperatively, a large pharyngocutaneous fistula developed. Attempted closure with a pectoralis major flap was unsuccessful. A tubed gastro-omental free flap based on the right gastroepiploic vessels was used to reconstruct the pharynx. The accompanying greater omentum was skin grafted after filling the large soft tissue defect in the neck. The wounds healed primarily, and oral alimentation was resumed on the seventh postoperative day.
  
  
  CONCLUSIONS
  The gastro-omental flap is a versatile composite flap which can provide mucosal lining as well as abundant soft tissue. It should be considered a secondary option in irradiated, complex pharyngeal wounds when local flaps are not available to be used in conjunction with free jujunal transfer.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Emory University, Atlanta, Georgia, USA.
authors.forename: G W
authors.initials: GW
authors.lastname: Carlson
authors.forename: V H
authors.initials: VH
authors.lastname: Thourani
authors.forename: M A
authors.initials: MA
authors.lastname: Codner
authors.forename: W J
authors.initials: WJ
authors.lastname: Grist
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery*; D005260:Female; D005402:Fistula / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000532:radiotherapy*; D009336:Necrosis; D009852:Omentum / Q000637:transplantation*; D010608:Pharyngeal Diseases / Q000209:etiology / Q000601:surgery*; D011832:Radiation Injuries / Q000150:complications / Q000601:surgery*; D013524:Surgical Flaps / Q000379:methods*; D014139:Tracheostomy / Q000009:adverse effects*; D014945:Wound Healing / Q000502:physiology