title: Hypopharyngeal reconstruction using remnant narrow pharyngeal wall as omega-shaped radial forearm free flap.
abstract: 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.
authors.affiliation: Department of Plastic & Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jong Won
authors.initials: JW
authors.lastname: Hong
authors.forename: Hii Sun
authors.initials: HS
authors.lastname: Jeong
authors.forename: Dae Hyun
authors.initials: DH
authors.lastname: Lew
authors.forename: Tai Suk
authors.initials: TS
authors.lastname: Roh
authors.forename: Kwan Chul
authors.initials: KC
authors.lastname: Tark
authors.forename: Eun Chang
authors.initials: EC
authors.lastname: Choi
authors.forename: Won Jai
authors.initials: WJ
authors.lastname: Lee
mesh_terms: 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