RECONSTRUCTION FOLLOWING TOTAL LARYNGOPHARYNGOESOPHAGECTOMY AND EXTENSIVE RESECTION OF THE SUPERIOR MEDIASTINUM

Our experience with four patients who underwent immediate reconstructi on following total laryngopharyngoesophagectomy and extensive resectio n of the superior mediastinum is presented. The reconstructive procedu res included free jejunal graft or microvascularly augmented gastric p edicle for esophageal reconstruction, pectoral fasciocutaneous or myoc utaneous flap for tracheal reconstruction, and mesenteric flap connect ed vith jejunal graft, omental flap, or pectoral flap for protection o f the great vessels and obliteration of the dead space in the cervical and superior mediastinal region. The reconstructive procedures were s uccessful, and no pharyngocutaneous fistula, mediastinitis, or great v essel rupture was noted in any patient. There was one patient who deve loped lung edema and liver dysfunction postoperatively. Combinations o f reconstructive procedures using well-vascularized soft tissues can b e expected to provide well-tolerated reconstruction following extensiv e cervical and superior mediastinal resection.