ONE-STAGE RECONSTRUCTION OF PARTIAL LARYNGOPHARYNGEAL DEFECTS

Advanced-stage lesions of the hypopharynx or tongue base often involve the larynx. The difficulty of reconstructing large partial laryngopha ryngeal defects can result in total laryngectomy being performed to av oid the assumed problems with aspiration. This article describes the f irst reported experience using the pectoralis musculocutaneous flap fo r primary one-stage reconstruction of laryngopharyngeal defects follow ing resection of advanced-stage lesions, to reconstruct both the laryn geal and the pharyngeal components of the defect. In this group of 21 patients, there were 16 with hypopharyngeal and 5 with tongue base can cers. Two had received prior treatment, and all received some form of postoperative radiotherapy and/or chemotherapy. Six patients experienc ed complications, including two fistulae, three wound infections, two myocardial infarctions, and one colon perforation. There were no insta nces of stenosis of the reconstructed segment. The length of hospitali zation ranged from 9 to 60 days, the average being 17 days. Forty-seve n percent (21) of the patients were not tolerating an oral diet at the time of discharge. However, 15 patients (71%) ultimately were eating by mouth, with 13 (62%) achieving an oral intake of liquids and solids . This analysis supports the hypothesis that the pectoralis major musc ulocutaneous flap is an effective one-stage primary reconstruction tec hnique for laryngopharyngeal defects in patients either who have recei ved prior therapy or who will receive postoperative therapy.