title: Combined pectoralis flap and gastric pull-up for pharyngeal reconstruction.
abstract: BACKGROUND
  The gastric transposition flap, "gastric pull-up," is one of the standard techniques of reconstruction after total laryngopharyngectomy. Under certain circumstances, this method may provide insufficient tissue for a tension-free closure. In these circumstances, the surgeon could either close under tension, risking the viability of the flap and probable fistula; create a pharyngostome; or recruit additional tissue. In this article, we describe the use of the pectoralis major myocutaneous flap in combination with the gastric pull-up for reconstruction.
  
  
  METHODS
  A retrospective review of three patients who underwent the procedure was performed, and a detailed description of the surgical technique is provided.
  
  
  RESULTS
  The procedure was performed in three patients, all of whom healed without wound infection or fistula.
  
  
  CONCLUSIONS
  The combination of a pectoralis flap with a gastric transposition is an alternative for cases in which a gastric flap alone is insufficient. With this combination virtually any defect of the upper aerodigestive tract can be successfully closed.
authors.affiliation: Department of Otolaryngology, Wayne State University School of Medicine, Detroit, Michigan, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Marks
authors.forename: Z
authors.initials: Z
authors.lastname: Steiger
mesh_terms: D006801:Humans; D007825:Laryngectomy; D010610:Pharyngeal Neoplasms / Q000601:surgery*; D010611:Pharyngectomy; D013524:Surgical Flaps / Q000379:methods*