Esophageal reconstruction with a skin-grafted pectoralis major muscle flap.

Reconstruction of the cervical esophagus is a problem in the surgical treatment of hypopharyngeal cancer. The conventional deltopectoral skin flap and the pectoralis major myocutaneous flap both have shortcomings. We developed a new technique for the immediate reconstruction of the entire cervical esophagus that utilizes the pectoralis major muscle with skin grafted directly onto it. This is especially useful in female patients who are buxom or have thick subcutaneous adipose tissue, because the anterior chest skin is not used as the skin island and, therefore, the flap is not too bulky and cosmetic problems are minimal. The breast is left unaffected with the nipple in its normal position. We report the technical details and the results in four female patients with hypopharyngeal cancer.