title: Delayed pharyngoesophageal reconstruction with combined local and regional flaps: a case report.
abstract: We describe an unusual technique for performing delayed pharyngoesophageal reconstruction following circumferential pharyngolaryngectomy. The patient was a 52-year-old man who underwent a circumferential pharyngolaryngectomy for the treatment of hypopharyngeal carcinoma. In view of the patient's poor clinical status, we opted to perform a pharyngostomy and an esophagostomy and to postpone pharyngoesophageal reconstruction for a more appropriate occasion. After the patient's clinical condition had sufficiently improved, the repair was planned. Microsurgical flaps were contraindicated because the blood flow through the cervical vessels was unreliable. Pharyngoesophageal continuity was restored with a cervical flap vascularized by the prevertebral fascia, a pectoralis major myocutaneous flap, and a deltopectoralis flap. A reasonable degree of deglutition was achieved, and no signs of stricture were detected. Although our technique was unusual, we believed that it might provide a valid alternative when a delayed pharyngoesophageal reconstruction is required and free flaps are contraindicated for any reason.
authors.affiliation: Department of Head and Neck Surgery, Hospital de Ensino da Faculdade de Medicina do ABC, Rua Carlos Tiago Pereira No. 915, Apt. 121, São Paulo 04150-080, Brazil. pintofr@uol.com.br
authors.forename: Fábio Roberto
authors.initials: FR
authors.lastname: Pinto
authors.forename: Jossi Ledo
authors.initials: JL
authors.lastname: Kanda
mesh_terms: D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D010611:Pharyngectomy; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps