FREE GASTROOMENTAL FLAP RECONSTRUCTION OF THE COMPLEX, IRRADIATED PHARYNGEAL WOUND

Background. Reconstruction of the complex pharyngeal wound after radio therapy presents a surgical challenge. Methods. Evaluation of the gast ro-omental flap in the reconstruction of the pharynx and overlying sof t tissue after local flap failure. Results. A 70-year-old patient unde rwent a total laryngectomy and radical neck dissection after 70 Gy of external beam radiotherapy for an advanced squamous cell carcinoma of the pyriform sinus. Postoperatively, a large pharyngocutaneous fistula developed. Attempted closure with a pectoralis major flap was unsucce ssful. A tubed gastro-omental free flap based on the right gastroepipl oic vessels was used to reconstruct the pharynx. The accompanying grea ter omentum was skin grafted after filling the large soft tissue defec t in the neck. The wounds healed primarily, and oral alimentation was resumed on the seventh postoperative day. Conclusions. The gastro-omen tal flap is a versatile composite flap which can provide mucosal linin g as well as abundant soft tissue. It should be considered a secondary option in irradiated, complex pharyngeal wounds when local flaps are not available to be used in conjunction with free jujunal transfer. (C ) 1997 John Wiley & Sons, Inc.