Hypopharyngeal reconstruction using remnant narrow pharyngeal wall as omega-shaped radial forearm free flap.
OBJECTIVE
There have been numerous attempts to use pharyngoesophageal reconstruction to restore swallowing function. Much controversy exist over reconstruction after total or partial pharyngectomy, and there is also debate over whether to continue with the reconstructive procedure with a narrow strip of remnant mucosa or complete it after total pharyngectomy. We analyzed the utility of omega-shaped radial forearm free flap (RFFF) using the narrow remnant posterior pharyngeal wall.


METHODS
Patients in group 1 (n = 12) had a narrow remnant pharyngeal wall with a width of less than 3 cm. Those in group 2 (n = 35) had a remnant pharynx with a width larger than 3 cm. The incidence of fistula, stricture, and swallowing difficulty were evaluated. Swallowing difficulty was graded using a 7-point visual analog scale. All circumferential hypopharyngeal reconstruction with tubed RFFF, pectoralis major flap, and jejunal free flap were also compared with group 1.


RESULTS
All flaps survived, and 1 fistula (8%) was detected in group 1. Compared with tubed RFFF (46%) and tubed pectoralis major flap (57%), this is a relatively low rate of fistula formation. In group 1, normal diet was possible in 92% of patients, but 1 patient can tolerate a liquid diet only. In group 2, normal diet was possible in 80% of patients. As for swallowing difficulty, the median visual analog scale score for both groups 1 and 2 was 6 points. When comparing different flaps, stricture and fistula rate was 0 and 8% in group 1, 15 and 46% in tubed RFFF, 43 and 57% in tubed pectoralis major flap, and 33 and 5% in jejunal flap, respectively.


CONCLUSIONS
We performed all surgeries taking care not to transgress the wide excision principle with the remnant hypopharyngeal wall. For remnant lesions greater than 3 cm, patch-type RFFF was performed, whereas for those less than 3 cm, omega-shaped RFFF was done. We achieved fairly good results in both groups without total resection of the narrow remnant hypopharyngeal wall.
Hong
Jong Won
JW
Department of Plastic & Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea.
Jeong
Hii Sun
HS
Lew
Dae Hyun
DH
Roh
Tai Suk
TS
Tark
Kwan Chul
KC
Choi
Eun Chang
EC
Lee
Won Jai
WJ
D000714:Anastomosis, Surgical / Q000379:methods; D003251:Constriction, Pathologic / Q000209:etiology; D003680:Deglutition Disorders / Q000209:etiology; D004032:Diet; D005500:Follow-Up Studies; D005542:Forearm / Q000601:surgery; D006085:Graft Survival; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery; D007013:Hypopharynx / Q000473:pathology / Q000601:surgery*; D007583:Jejunum / Q000637:transplantation; D007825:Laryngectomy / Q000145:classification; D016155:Oral Fistula / Q000209:etiology; D010369:Pectoralis Muscles / Q000637:transplantation; D010608:Pharyngeal Diseases / Q000209:etiology; D010611:Pharyngectomy / Q000145:classification*; D010614:Pharynx / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D011884:Radius; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000145:classification*; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome