PHARYNGOESOPHAGEAL RECONSTRUCTION WITH THE ULNAR FOREARM FLAP

Objective: To evaluate the use of a generous fasciocutaneous ulnar for earm free flap in pharyngoesophageal reconstruction. Design: Tertiary referral center. Setting: Private practice. Patients: From September 1 , 1991, to October 30, 1996, 20 ulnar forearm free flaps were used to reconstruct the pharyngoesophagus in 19 patients after surgery for squ amous cell carcinoma. There were 13 circumferential defects and 7 near -circumferential defects (<2 cm of mucosa remaining). The reconstructi ons were performed primarily (at the time of tumor resection) in 16 ca ses and secondarily in 4 cases. Intervention: A generous fasciocutaneo us ulnar forearm flap with a minimum dimension of 9 x 22 cm was harves ted to reconstruct the pharyngoesophagus, A 2-layer closure was perfor med in flap tailoring and proximal (pharynx to flap) and distal (flap to esophagus) anastomoses to minimize the risk of leakage. Also, porti ons of the flap were used to monitor flap viability, to cover cervical vessels, to obliterate dead space, and as skin coverage when the skin flaps were deficient. Results: Nineteen of the 20 flaps transferred w ere successful. Swallow function was restored in 18 cases; and voice w as rehabilitated in all the patients using either tracheoesophageal pu ncture and a voice device or an electrolarynx device. There was 1 peri operative mortality. Three fistulas occurred, all of which healed with non-surgical treatment. One stricture developed that required intermi ttent dilatation. The donor site morbidity was minor. Conclusions: Thi s versatile technique achieves excellent results with a decreased comp lication rate compared with other methods currently available in phary ngoesophageal reconstruction.