Reconstruction of circumferential pharyngeal defect following cancer surgery with tubed pectoralis major myocutaneous flap and interdigitating anastomosis

Abstract

Hypopharyngeal cancer has a poor prognosis and the tumor may spread submucosally to involve all the pharyngeal mucosa. Reconstruction of circumferential defects after resection of hypopharyngeal cancer is a challenge. We describe our results using a tubed fan-shaped pectoralis major myocutaneous flap and distal interdigitating anastomosis to reconstruct a circumferential pharyngeal defect following surgical resection in six patients with advanced hypopharyngeal cancer. There was no perioperative mortality in this study. Fistula formation occurred in three patients and was corrected by secondary closure in two and spontaneous healing in one. Oral intake was started 2 weeks to 2 months after surgery. Four patients died of distant metastases within 24 months of follow-up and two survived without disease. Neither locoregional recurrence nor stenosis occurred. Our results show that the tubed fan-shaped pectoralis major myocutaneous flap with distal interdigitating anastomosis is a reliable way to reconstruct circumferential pharyngeal defects, and is relatively noninvasive.