LONG-TERM FUNCTIONAL RESULTS AFTER PHARYNGOESOPHAGEAL RECONSTRUCTION WITH THE RADIAL FOREARM FREE-FLAP

For recovery to be deemed adequate, the laryngectomized patient requir es restoration of both the ability to swallow and to speak. Immediate results and long-term functional recovery after pharyngoesophageal (PE ) reconstruction with the radial forearm free flap were studied in 22 consecutive patients who had undergone primary (n = 3) or secondary (n = 19) reconstructions after total laryngectomy. Circumferential recon structions were done in 13 patients (mean length 10 cm, range 6 to 16) and patch reconstructions in 9 patients (defect size range 4 X 4 cm t o 8 X 7 cm). Flap leakage was evaluated for all patients, and postoper ative diet and ability to swallow were evaluated for 16 patients with an intact tongue base. Voice were evaluated for 6 patients with circum ferential reconstructions who had later undergone tracheoesophageal pu ncture with placement of a Blom-Singer voice prosthesis, and the resul ts compared with those of a control group of 5 voice-restored patients who had undergone laryngectomy with primary closure of the pharyngoes ophagus. All 22 flaps survived and none of the patients died. Although 7 (32%) reconstructions leaked, all but 1 closed spontaneously. Fourt een (88%) of the patients with an intact tongue base have no dysphagia and are on a regular diet, and 2 remain on an oral liquid diet. Compa red with controls, patients with a radial free-flap reconstruction had similar loudness with soft speech (43 dB for controls versus 52 dB fo r radial patients) and loud speech (61 dB versus 63 dB), comparable fu ndamental frequencies (136 Hz versus 125 Hz), and increased jitter (2% versus 5%). Speech intelligibility was judged by unstrained listeners as excellent for 4 of the patients with radial flaps and good for the other 2. The radial free flap offers the advantages of rapid harvest, high flap reliability, and minimal donor-site and patient morbidity. Leakage rate and deglutition restoration were similar to those of othe r reconstructions, including the free jejunal flap. Speech rehabilitat ion in patients secondarily reconstructed with the radial free flap wa s nearly equivalent to that of total laryngectomy patients who have pr imary closure of the pharynx and was superior to that reported with ot her popular PE reconstructions, including the gastric pull-up and the free jejunal flap.