Application of laryngotracheal flap in the reconstruction of the postoperative defect of the hypopharynx carcinoma involving cervical esophagus

OBJECTIVE To evaluate the value of the laryngotracheal tissue flap in the reconstruction of postoperative defect of the hypopharynx carcinoma involving cervical esophagus. METHODS A retrospective study of 15 cases with postoperative defect of the hypopharynx carcinoma involving cervical esophagus which was reconstructed using the laryngotracheal tissue flap was carried out. The defects were reconstructed with laryngotracheal tissue flap and unilateral bipedicle muscular flap simultaneously in 10 cases,with laryngotracheal tissue flap,unilateral bipedicle muscular flap and prevertebral fascia in 3 cases,with laryngotracheal tissue flap,unilateral bipedicle muscular flap and pectoralis major myocutaneous flaps in 2 cases. Four cases reinforced the defects with the sternocleidomastoid muscle. RESULTS No necrosis of the flaps were found after reconstruction. Five cases healed with complication of small pharyngeal fistula. One case recurred in the base of tongue 8 months after operation,and died 13 months after reoperation. One case died of local recurrence 18 months after operation. One case was found contralateral cervical lymph node metastasis at level II and survived after operation. One case was found lung metastases,and received chemotherapy and survived. One case was found recurrence 36 months after operation,received radiotherapy and survived. Twelve cases recovered the function of deglutition at 16 days after operation,and among these 12 cases,10 cases had good recovery of the voice function at the same time. Five cases which had complication of pharyngeal fistula healed in one month and their swallowing function recovered as well. According to the results of follow-up and by the KaplanMaier method,the 3-year and 5-year survival rates were 61.5% and 37.5% respectively. CONCLUSION The laryngotracheal tissue flap is a good option for the defect of the hypopharyngeal carcinoma involving the cervical esophagus. As a method of reconstruction,it was convenient,less damage and few complications.