title: A fabricated forearm free flap with accompanying phonation tube for simultaneous reconstruction of a pharyngolaryngeal circumferential defect and voice loss: new surgical modification with functional phonation outcome.
abstract: BACKGROUND
  Total pharyngolaryngectomy is potentially ablative surgery, resulting in compromise of some most basic functions of life, including speech and swallowing. Tracheoesophageal puncture is the gold standard for voice restoration. But it still has prosthesis-related problems.
  
  
  OBJECTIVE
  We designed a uniquely customized radial forearm free flap (RFFF), which also incorporated a region for phonation tube (PT) creation, for the dual purpose of circumferential laryngopharyngeal defect reconstruction and voice production.
  
  
  METHODS
  From August 2005 to September 2010, there were 18 male patients with late-stage hypopharyngeal cancer (HPC) or laryngeal cancer (LC) who received one-stage reconstruction with the fabricated RFFF-accompanying PT after total pharyngolaryngectomy. We recorded the phonation outcome of phonation efficacy (PE) and maximal phonation time (MPT) postoperatively within 1 month and at least 1 year after surgery.
  
  
  RESULTS
  Nine patients suffered from HPC and the others suffered from LC. Twelve patients received concurrent chemoradiotherapy after surgery. The follow-up time was 12 to 56 months (mean 28.7 months). There was no significant variance in the PE (79.72%, SD=21.93% vs. 62.50%, SD=39.60%, respectively; p = 0.115) and MPT (2.58 seconds, SD=1.80 vs. 2.97 seconds, SD=3.96, respectively; p = 0.878) between the first and last follow-up points, even when the patients were grouped by radiotherapy status after surgery or by disease group.
  
  
  CONCLUSIONS
  The phonation outcome in our experience was satisfactory and it tolerated postoperative radiotherapy during at least the 12-month follow-up period.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Jehn-Chuan
authors.initials: JC
authors.lastname: Lee
authors.forename: Wei-Ting
authors.initials: WT
authors.lastname: Hsu
authors.forename: Cheng-Chien
authors.initials: CC
authors.lastname: Yang
authors.forename: Shih-Hsin
authors.initials: SH
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy; D005542:Forearm / Q000601:surgery; D058752:Free Tissue Flaps; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000503:physiopathology / Q000601:surgery*; D007822:Laryngeal Neoplasms / Q000503:physiopathology / Q000601:surgery*; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D010611:Pharyngectomy / Q000379:methods*; D010699:Phonation / Q000502:physiology*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome