COMBINED PECTORALIS FLAP AND GASTRIC PULL UP FOR PHARYNGEAL RECONSTRUCTION

Background: The gastric transposition flap, ''gastric pull-up,'' is on e of the standard techniques of reconstruction after total laryngophar yngectomy. Under certain circumstances, this method may provide insuff icient tissue for a tension-free closure. In these circumstances, the surgeon could either close under tension, risking the viability of the flap and probable fistula; create a pharyngostome; or recruit additio nal tissue. In this article, we describe the use of the pectoralis maj or myocutaneous flap in combination with the gastric pull-up for recon struction. Methods: A retrospective review of three patients who under went the procedure was performed, and a detailed description of the su rgical technique is provided. Results: The procedure was performed in three patients, all of whom healed without wound infection or fistula. Conclusions: The combination of a pectoralis flap with a gastric tran sposition is an alternative for cases in which a gastric flap alone is insufficient. With this combination virtually any defect of the upper aerodigestive tract can be successfully closed. (C) 1997 John Wiley & Sons, Inc.