Reconstruction of the circumferential hypopharyngoesophageal defect with laryngotracheal flap and pectoralis major myocutaneous flap

OBJECTIVE To study the reliability and efficacy of laryngotracheal flap and pectoralis major myocutaneous flap in the reconstruction of circumferential hypopharyngo-esophageal defects. METHODS From Dec.2002 to Apr. 2005,20 patients with advanced hypopharyngeal cancer received surgical treatment. All of them were men,including T3 lesions in 11 cases and T4 in 9 cases. A 2 to 7 cm circumferential defects were left in hypopharyngoesophageal area after resection the tumors,which was reconstructed with combined contralateral unaffected laryngotracheal flap and pectoralis major myocutaneous flap. RESULTS All of the 20 combined flaps were alive. Small pharyngocutaneous fistulas were found in 2 patients after operation. The wounds were healed well in other 18 cases. All of the 20 patients resumed a regular diet. Their swallowing function restored to normal by X-ray examination. No stenosis was found. No local recurrences were found during follow-up period(7～40 months;median 27 months) in all of 20 patients. Four cases died due to cervical recurrences(2 cases) ,midiastinum metastasis(1 case) and lung metastasis(1 case) at 7,12,17 and 24months after operation. The 1 and 3 year survival rates were 89.95% and 72.65% respectively. CONCLUSION The primary result shows that this technique is a simple,safe and effective method with low morbidity and satisfi ed oncologic and functional results.