[Reconstruction of hypopharynx after pharyngolaryngectomy with U-shaped radial forearm flap].

BACKGROUND

After pharyngolaryngectomy reconstructive procedures of the upper digestive tract are necessary. Since the introduction of microvascular tissue transplantation jejunal loops proved to be a versatile transplant. Nevertheless it has some disadvantages as i. e. the increased donor morbidity, a rather high sensitivity to hypoxia and the tendency of shrinkage and formation of stenosis.

METHOD: We perform the reconstruction of the hypopharynx with the radial forearm flap. The fasciocutaneous flap is harvested on the radial artery in a size of 12 x 6 cm in average and is sutured U-shaped paramedian to the prevertebral fascia. In addition the posterior wall of the oesophagus and the oropharynx have to be adapted to the prevertebral fascia.

RESULTS

Between 1997 and 2001 we performed these reconstructions in 20 patients. In one case we found a complete flap necrosis, which required secondary reconstruction with a pectoralis major flap. In 2 patients we saw a stenosis at the junction to the oesophagus, which was treated by revision surgery and bougienage. In 18 patients swallowing was regular. 6 patients were able to learn oesophageal speech.

CONCLUSION

The radial forearm flap in its U-shaped transposition to the prevertebral fascia represents a functionally good reconstructive procedure for the hypopharynx.