title: Morbidity and functional outcomes following gastro-omental free flap reconstruction of circumferential pharyngeal defects.
abstract: BACKGROUND
  In patients with extensive soft tissue fibrosis requiring circumferential pharyngeal reconstruction following definitive radiotherapy and/or chemotherapy, we take advantage of abundant omental progenitor factors in the tubed gastro-omental free flap. This study reviews our experience with this flap.
  
  
  METHODS
  Review of 11 patients (median follow-up, 2.8 years) undergoing total pharyngolaryngectomy following organ preservation protocols for recurrent squamous cell carcinoma (n = 9) and stricture (n = 2).
  
  
  RESULTS
  Operative morbidity and mortality rates were 54% and 9%, respectively. One patient died following carotid rupture. Complications included: chyle leak (18%), pharyngocutaneous fistula (9%), and late stricture (27%). Ten patients (91%) achieved oral diet, and all 7 patients (100%) considered suitable for tracheoesophageal speech rehabilitation achieved functional speech. Seven patients remain alive without disease at a median of 41 months following surgery.
  
  
  CONCLUSIONS
  The gastro-omental flap provides a viable option in high-risk patients undergoing circumferential pharyngeal reconstruction.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Rajan S
authors.initials: RS
authors.lastname: Patel
authors.forename: Antti A
authors.initials: AA
authors.lastname: Makitie
authors.forename: David P
authors.initials: DP
authors.lastname: Goldstein
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Gullane
authors.forename: Dale
authors.initials: D
authors.lastname: Brown
authors.forename: Jonathan
authors.initials: J
authors.lastname: Irish
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Gilbert
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery; D003251:Constriction, Pathologic / Q000601:surgery; D003679:Deglutition; D005260:Female; D005402:Fistula / Q000209:etiology / Q000601:surgery; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000098:blood supply / Q000637:transplantation; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000628:therapy; D006406:Hematoma / Q000209:etiology / Q000601:surgery; D046449:Hernia, Abdominal / Q000209:etiology / Q000601:surgery; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000401:mortality / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000601:surgery; D007825:Laryngectomy; D007831:Larynx, Artificial; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009852:Omentum / Q000098:blood supply / Q000637:transplantation; D010614:Pharynx / Q000601:surgery*; D011183:Postoperative Complications; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000601:surgery; D016879:Salvage Therapy; D013060:Speech; D013524:Surgical Flaps / Q000098:blood supply; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000601:surgery