The lateral island trapezius myocutaneous flap for circumferential reconstruction of hypopharynx and cervical esophagus.
The lateral island trapezius was utilized for reconstruction of hypopharyngeal and cervical esophagus defects in high-risk patients, avoiding entry into the celomic cavities as an approach to decrease morbidity and mortality. Seven male patients were treated at the State University of New York between 1988 and 1991 and underwent reconstruction with the lateral island trapezius flap. There was no mortality, 2 patients developed pharyngocutaneous fistulas; 1 patient operated after radiation treatment failure remained with positive margins at resection but his fistula never healed, and another patient underwent a minor revision with successful closure of the fistula. All patients regained swallowing and none required dilatations. The preferred methods of reconstruction for the reasonable risk patient are gastric pull-up and free jejunal transfer; both of which require entry into cavities. The lateral island is a reliable alternate method of reconstruction for high-risk patients in whom intracavitary surgery may lead to unacceptably high morbidity and mortality. When the vascular anatomy is not favorable, rerouting of the vessels may be required utilizing microvascular reconstruction. The donor site defect is closed primarily or skin grafted, and subsequent functional limitations are minimal and well tolerated.
Castillo
M H
MH
Department of Surgery, Wright State University School of Medicine, Dayton, Ohio, USA.
Peoples
J B
JB
Machicao
C N
CN
Singhal
P K
PK
D000368:Aged; D001415:Back; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D017577:Cutaneous Fistula / Q000209:etiology; D004938:Esophageal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D005402:Fistula / Q000209:etiology; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010608:Pharyngeal Diseases / Q000209:etiology; D012086:Reoperation; D012307:Risk Factors; D013524:Surgical Flaps / Q000009:adverse effects; D016896:Treatment Outcome