PHARYNGOESOPHAGEAL RECONSTRUCTION USING THE RADIAL FOREARM FASCIOCUTANEOUS FREE-FLAP - PRELIMINARY-RESULTS

Pharyngoesophageal reconstruction remains a challenge to the head and neck surgeon. The goals of pharyngoesophageal reconstruction include r estoration, with minimal morbidity, of a person's ability to swallow a nd to speak. Myocutaneous flaps, gastric pull-up, and the jejunal free flap are popular methods of pharyngoesophageal reconstruction; howeve r, none of these modalities is clearly ideal. We have begun utilizing the radial forearm fasciocutaneous free flap for pharyngoesophageal re construction. Twelve patients have had reconstruction with this flap w ith follow-up from 2 to 15 months. Seven defects were circumferential, and five were noncircumferential. Ten patients (83%) have had success ful restoration of both swallowing ability and voice. Donor site morbi dity was minimal. The leading complication was salivary leak, which wa s present in eight (67%) patients. Five of the leaks closed with nonsu rgical intervention. No cases of flap necrosis occurred. The radial fo rearm free flap is a thin and pliable flap that closely approximates t he tissue consistency of normal pharynx. Successful restoration of a p atient's ability to swallow approximates that of enteral flaps and is superior to that of MC flaps. Successful speech restoration is superio r to that of enteral and MC flaps. Donor site morbidity is less than t hat caused by enteral flaps because laparotomy is avoided. Salivary le ak is higher than with enteral flaps. Part of this difference is accou ntable to the high number of secondary and technically challenging rec onstructions in this series, and we have taken steps to lower this rat e of leakage. These preliminary data show that the radial forearm fasc iocutaneous free flap is well suited for pharyngoesophageal reconstruc tion. Additional experience with this flap for pharyngoesophageal reco nstruction is necessary to fully evaluate its utility.