RECONSTRUCTION OF A COMPLEX HYPOPHARYNGEAL CERVICAL DEFECT WITH A SINGLE LATISSIMUS-DORSI FREE-FLAP

Large, complex hypopharyngeal defects that include mucosa and cervical skin, and that result from debridement of orocutaneous fistulas secon dary to failed repairs of laryngectomy defects, are difficult to treat , especially when previous irradiation has damaged adjacent tissues. W e have found that such defects can be repaired sufficiently in one sta ge using a latissimus dorsi musculocutaneous free flap. The wound is d ebrided until only healthy tissue remains. The skin paddle of the free flap is then used to reconstruct the hypopharyngeal mucosal defect, w hereas the muscular portion serves to cover any cervical tissue that r emains exposed. A split-thickness skin graft is then placed over the m uscle to complete the repair. The resulting reconstruction is free of excess bulk, has no radiation damage, is well vascularized, and has an acceptable appearance.