Introduction
Circumferential laryngopharyngectomy and cervical oesophagectomy present a unique reconstructive challenge due to the complete loss of both the anterior and posterior pharyngeal walls, requiring mobilisation of adequate tissue to create the neopharynx. 1-2 The radial forearm free flap (RFFF), the latissimus dorsi flap, the anterolateral thigh flap, the free jejunal flap (FJF) and the pectoralis major myocutaneous flap (PMMC) are more commonly described in the literature for reconstruction used either tubed or by suturing the flap in a ‘horseshoe-shaped’ fashion to the prevertebral fascia3-5 In the early surgical series, the use of free flaps was associated with a higher rate of post-operative fistula formation (up to 67%) compared to PMMC flap reconstruction (22%)6-7 but the percentage of such complications in the former groups has significantly improved in more recent studies (11-14% fistula;14-16% stenosis). 8 However, the biggest challenge is regarding the long-term functional outcomes of swallow and speech, which remain poor and difficult to produce good outcomes consistently.
We describe our experience with the use of a deltopectoral flap for reconstruction of the posterior pharyngeal wall and another flap (pectoralis major or supraclavicular flap in our case series) to complete the reconstruction of the circumferential pharyngo-oesophageal defects.