Reconstruction of circumferential defect of the hypopharynx: experimental studies and clinical application of a new method.

Reconstruction of circumferential defect of the hypopharynx is a challenging problem in head and neck surgery. Reconstruction with a totally tubed pectoralis major myocutaneous flap (PMMCF) has been advocated in recent years, but this procedure has the disadvantage of excessive bulkiness. In order to solve this problem, the author experimented with a partially tubed platysma myocutaneous flap and an inner surface of apron skin flap of the anterior neck in the reconstruction of the circumferential defect of the hypopharynx in ten dogs. Subsequently, the same surgical technique using PMMCF instead of the platysma myocutaneous flap was used for reconstruction following total laryngopharyngectomy in eight patients. The new partially tubed flap was successful in solving the problem of excessive bulkiness of the totally tubed PMMCF.