RECONSTRUCTION OF PHARYNGOSTOMES WITH A MODIFIED DELTOPECTORAL FLAP COMBINING ENDOSCOPY AND TISSUE EXPANSION

The problem of pharyngostomic closure is difficult to serve, as eviden ced by the large number of techniques described. The authors present t he reconstruction of pharyngostomes by using Bakamjian's deltopectoral flap modified by the use of endoscopically introduced expanders for t hose patients in whom other techniques of choice (such as vascularized free flaps) have failed or are inapplicable either because of previou s radiotherapy or because of local conditions. Bakamjian's deltopector al flap, previously expanded with an expander coated with a partial-th ickness skin graft and introduced endoscopically, allowed the authors to lift the flap in one operation to close the pharyngostome. This met hod provides the two walls of the pharynx (the skin graft as the inner aspect and the skin flap as the outer aspect), and the donor deltopec toral area is covered and epithelialized due to the skin graft. Thus b y means of endoscopic expansion we use a nonaggressive technique to in crease the surface area of the donor site and to increase its vascular ization (delay phenomenon). Because the expander was coated with the g raft, the authors were able to cover the anterior wall of the pharyngo stome and the donor site in one surgical step.