OBJECTIVES: Combined defects of the skin, larynx,
pharynx, and esophagus after central compartment exenteration can be extremely difficult to reconstruct. The objective of this paper is to
evaluate reconstruction of the central compartment using a combination of free
jejunal transfer for pharyngoesophageal reconstruction, together with regional
deltopectoral flaps for tracheostomal reconstruction and cutaneous resurfacing.
Myocutaneous flaps, such as pectoralis major and latissimus
dorsi flaps, have been used
previously for external coverage but can be bulky causing obstruction of the
tracheostoma.
METHODS: From 1995 to 2002, 7 patients underwent
reconstruction of the central compartment with 7 jejunal and 9 deltopectoral
flaps. 5 patients required
resection for tracheostomal recurrence of squamous cell carcinoma, while 2 patients required resection
for massive pharyngocutaneous fistulae. 6 patients had received previous
radiotherapy. Flap survival,
complications and outcomes were evaluated retrospectively.
RESULTS: Mean age was 68.7 years. Mean follow-up was 1.9 years. Overall free jejunal and deltopectoral flap
survival was 100% with no partial loss.
All patients maintained an adequate airway with stoma patency. Complications are summarized in Table 1.
CONCLUSIONS: These complicated defects can be
effectively repaired with free jejunal transfers to
restore continuity of the alimentary tract, and deltopectoral flaps to reconstruct the tracheostoma and surrounding cutaneous defects.
The deltopectoral flap provides a large volume
of well-vascularized tissue that provides reliable
coverage of the newly reconstructed cervical esophagus and exposed major vessels
following exenteration of the central
compartment. Its thin, pliable
nature allows suturing of the tracheal remnants to skin edges without tension,
and avoids intraluminal prolapse of excess soft tissues thus maintaining stomal patency.
TABLE 1.
|
COMPLICATIONS
|
Total
No.
( n=7) |
|
MAJOR |
|
|
Peri-operative mortality |
1 |
|
Pharyngocutaneous fistula |
1 |
|
MINOR |
|
|
Subclincal pharyngocutaneous leak |
1 |
|
Cellulitis |
1 |
