title: Reconstruction of circumferential pharyngeal defects after tumour resection: reference or preference.
abstract: BACKGROUND
  Reconstruction of circumferential hypopharyngeal defects is often challenging. The aim of the study is to examine the result of our experience and to formulate improved management guidelines.
  
  
  METHODS
  Between 1980 and 2009, all patients who have circumferential pharyngectomy were recruited. Data were recorded prospectively for analysis.
  
  
  RESULTS
  A total of 202 patients were recruited. Majority had primary tumour in the hypopharynx (n=165), and the remaining patients had recurrent laryngeal carcinoma. Radiotherapy was given preoperatively in 72 patients and postoperatively in 108 patients. A pectoralis major (PM) flap was used in 92 (45.5%) patients, a free anterolateral thigh (ALT) flap in 24 (11.9%) patients and a free jejunal flap in 86 (42.6%) patients. Early fistula rate was 23.9% in the PM flap group, 12.5% in the ALT group and 4.6% in the jejunum group. Late anastomotic stricture rate was 27.2% in the PM flap group, 12.5% in the free ALT group and 2.3% in the jejunum group. Early fistula formation significantly increased the risk of subsequent anastomotic stricture (p=0.023). In patients with no stricture, 61.9% of them in the jejunal group were able to resume solid diet, compared with 35.8% and 38.1% in the PM and ALT groups. After PM flap harvesting, 34.8% of the chest wall defects could not be closed primarily, which were best repaired using the lateral thoracic flap. The donor-site morbidity of ALT and jejunal flap was low.
  
  
  CONCLUSIONS
  In suitable patients, free jejunal flap reconstruction of circumferential pharyngectomy defects achieves the best functional outcome with minimal donor-site morbidity.
authors.affiliation: Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China. chanjyw@gmail.com
authors.forename: Yu Wai
authors.initials: YW
authors.lastname: Chan
authors.forename: Raymond Wai Man
authors.initials: RW
authors.lastname: Ng
authors.forename: Lawrence Hin Lun
authors.initials: LH
authors.lastname: Liu
authors.forename: Hon Ping
authors.initials: HP
authors.lastname: Chung
authors.forename: William Ignace
authors.initials: WI
authors.lastname: Wei
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000209:etiology; D017577:Cutaneous Fistula / Q000209:etiology; D003680:Deglutition Disorders / Q000209:etiology; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery*; D007583:Jejunum / Q000637:transplantation; D007822:Laryngeal Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010369:Pectoralis Muscles / Q000637:transplantation; D010611:Pharyngectomy; D011183:Postoperative Complications; D011446:Prospective Studies; D013524:Surgical Flaps