Surgical treatment of pharyngostomes in irradiated patients. Our experience with musculocutaneous pectoralis major flap and hyperbaric oxygen therapy.
CONCLUSIONS
Our experience confirms that pectoralis major flap is the first-choice technique for repairing recurrent hypopharyngeal fistulae in previously irradiated patients in whom microsurgical techniques are not indicated, and that hyperbaric oxygen therapy helps to solve this complex pathology.


OBJECTIVE
A pharyngostome is a complication encountered when performing surgical operations on pharyngolaryngeal structures. The authors present their experience of treating recurrent complex pharyngostomes in previously irradiated patients in poor physical health. These patients need a simple, safe reconstruction with a low incidence of postoperative complications.


METHODS
A pedicled pectoralis major flap was used for reconstruction: the skin side of the flap was used to restore the continuity of the pharyngeal mucosa, while the muscle was used to reconstruct the intermediate layer. The skin layer was completed by means of a free skin graft. In all cases, surgical treatment was combined with hyperbaric oxygen therapy before and after the operation.


RESULTS
A total of 10 patients, all of whom had previously undergone surgery and radiotherapy, had recurring or pluri-recurring pharyngostomes. All patients (8 males, 2 females; age range 52-80 years) had previously been affected by carcinoma of the pharyngolaryngeal region. All underwent major local Ablation together with radical neck dissection and radiotherapy. In all cases there was mucosa on the posterior wall; a musculocutaneous pectoralis major flap was used in all cases for reconstruction.
Cordova
A
A
Dipratimento di Discipline Chirurgiche ed Oncologiche, Divisione di Chirurgia Plastica e Ricostruttiva, Facolta di Medicina, Universita di Palermo, Palermo, Italy. chirplas@unipa.it
Corradino
B
B
Pirrello
R
R
Di Lorenzo
S
S
Dispenza
C
C
Moschella
F
F
D000368:Aged; D000369:Aged, 80 and over; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D007822:Laryngeal Neoplasms / Q000532:radiotherapy / Q000601:surgery; D007825:Laryngectomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010369:Pectoralis Muscles / Q000601:surgery*; D010608:Pharyngeal Diseases / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D010610:Pharyngeal Neoplasms / Q000532:radiotherapy / Q000601:surgery; D011183:Postoperative Complications; D018714:Radiotherapy, Adjuvant; D019651:Plastic Surgery Procedures / Q000379:methods; D013524:Surgical Flaps; D016896:Treatment Outcome