title: Optimizing Outcomes in Pharyngoesophageal Reconstruction and Neck Resurfacing: 10-Year Experience of 294 Cases.
abstract: BACKGROUND
  Pharyngoesophageal reconstruction is a complex endeavor that poses many challenges. This 10-year series examines factors impacting the need for neck skin resurfacing and evaluates the impact of reconstructive modalities on outcomes.
  
  
  METHODS
  A review identified 294 patients who underwent pharyngoesophageal reconstruction from 2002 to 2012. Patients were divided based on neck skin resurfacing requirements. Patients undergoing neck resurfacing were further subdivided into reconstructive technique, including a second skin paddle or muscle component from the same free flap pedicle, a local flap, or a second free flap. All groups were compared by comorbidities, complications, and functional outcomes.
  
  
  RESULTS
  Of 294 patients, 179 (60.9 percent) required neck skin resurfacing. In the resurfaced group, there were 90 circumferential defects (50.3 percent) and 89 partial defects (49.7 percent). In the resurfaced group, 110 (61.4 percent) underwent reconstruction with a second skin paddle from the same free flap pedicle, 21 (11.7 percent) underwent reconstruction with a muscle component from the same pedicle, and 25 (13.9 percent) received a pectoralis major flap. There were five external paddle flap losses in the resurfaced group (2.8 percent) and no internal flap losses. Overall complications were similar among groups. The resurfaced group had a lower pharyngocutaneous fistula rate (4.5 percent) compared with the primary closure group (11.3 percent) (p = 0.026). Prior neck surgery and radiation therapy were strong predictors of neck skin resurfacing (p < 0.001).
  
  
  CONCLUSIONS
  Neck resurfacing is often required in salvage pharyngoesophageal reconstruction. Providing additional vascularized tissue over the neoconduit is predictive of lower pharyngocutaneous fistula rates. An algorithmic approach to neck resurfacing is presented.
authors.affiliation: Rochester, Minn.; Houston, Texas; Pittsburgh, Pa.; Lévis, Quebec, Canada; and Columbus, Ohio.|From the Division of Plastic Surgery, Mayo Clinic; the Division of Plastic Surgery, Baylor College of Medicine; the Department of Plastic Surgery, University of Pittsburgh; Hôtel-Dieu de Lévis; the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center; and the Division of Plastic Surgery, The Ohio State University.
authors.forename: Basel
authors.initials: B
authors.lastname: Sharaf
authors.affiliation: Rochester, Minn.; Houston, Texas; Pittsburgh, Pa.; Lévis, Quebec, Canada; and Columbus, Ohio.|From the Division of Plastic Surgery, Mayo Clinic; the Division of Plastic Surgery, Baylor College of Medicine; the Department of Plastic Surgery, University of Pittsburgh; Hôtel-Dieu de Lévis; the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center; and the Division of Plastic Surgery, The Ohio State University.
authors.forename: Amy
authors.initials: A
authors.lastname: Xue
authors.affiliation: Rochester, Minn.; Houston, Texas; Pittsburgh, Pa.; Lévis, Quebec, Canada; and Columbus, Ohio.|From the Division of Plastic Surgery, Mayo Clinic; the Division of Plastic Surgery, Baylor College of Medicine; the Department of Plastic Surgery, University of Pittsburgh; Hôtel-Dieu de Lévis; the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center; and the Division of Plastic Surgery, The Ohio State University.
authors.forename: Mario G
authors.initials: MG
authors.lastname: Solari
authors.affiliation: Rochester, Minn.; Houston, Texas; Pittsburgh, Pa.; Lévis, Quebec, Canada; and Columbus, Ohio.|From the Division of Plastic Surgery, Mayo Clinic; the Division of Plastic Surgery, Baylor College of Medicine; the Department of Plastic Surgery, University of Pittsburgh; Hôtel-Dieu de Lévis; the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center; and the Division of Plastic Surgery, The Ohio State University.
authors.forename: Olivier
authors.initials: O
authors.lastname: Boa
authors.affiliation: Rochester, Minn.; Houston, Texas; Pittsburgh, Pa.; Lévis, Quebec, Canada; and Columbus, Ohio.|From the Division of Plastic Surgery, Mayo Clinic; the Division of Plastic Surgery, Baylor College of Medicine; the Department of Plastic Surgery, University of Pittsburgh; Hôtel-Dieu de Lévis; the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center; and the Division of Plastic Surgery, The Ohio State University.
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.affiliation: Rochester, Minn.; Houston, Texas; Pittsburgh, Pa.; Lévis, Quebec, Canada; and Columbus, Ohio.|From the Division of Plastic Surgery, Mayo Clinic; the Division of Plastic Surgery, Baylor College of Medicine; the Department of Plastic Surgery, University of Pittsburgh; Hôtel-Dieu de Lévis; the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center; and the Division of Plastic Surgery, The Ohio State University.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Hanasono
authors.affiliation: Rochester, Minn.; Houston, Texas; Pittsburgh, Pa.; Lévis, Quebec, Canada; and Columbus, Ohio.|From the Division of Plastic Surgery, Mayo Clinic; the Division of Plastic Surgery, Baylor College of Medicine; the Department of Plastic Surgery, University of Pittsburgh; Hôtel-Dieu de Lévis; the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center; and the Division of Plastic Surgery, The Ohio State University.
authors.forename: Roman
authors.initials: R
authors.lastname: Skoracki
authors.affiliation: Rochester, Minn.; Houston, Texas; Pittsburgh, Pa.; Lévis, Quebec, Canada; and Columbus, Ohio.|From the Division of Plastic Surgery, Mayo Clinic; the Division of Plastic Surgery, Baylor College of Medicine; the Department of Plastic Surgery, University of Pittsburgh; Hôtel-Dieu de Lévis; the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center; and the Division of Plastic Surgery, The Ohio State University.
authors.forename: Peirong
authors.initials: P
authors.lastname: Yu
authors.affiliation: Rochester, Minn.; Houston, Texas; Pittsburgh, Pa.; Lévis, Quebec, Canada; and Columbus, Ohio.|From the Division of Plastic Surgery, Mayo Clinic; the Division of Plastic Surgery, Baylor College of Medicine; the Department of Plastic Surgery, University of Pittsburgh; Hôtel-Dieu de Lévis; the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center; and the Division of Plastic Surgery, The Ohio State University.
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Selber
mesh_terms: D000465:Algorithms; D003679:Deglutition / Q000502:physiology; D062109:Dermatologic Surgical Procedures / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery*; D010614:Pharynx / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D013060:Speech; D016896:Treatment Outcome