One-stage reconstruction of defects in the hypopharyngeal region with freeflaps

Despite the almost universal poor prognosis, the reconstruction of combined cervical skin and hypopharyngeal defects after extensive resection of tumo ur should maintain optimal quality of life. From 1992 to 1996 we treated 10 patients with combined skin and hypopharyngeal defects with five fasciocut aneous free flaps, three myocutaneous latissimus dorsi free flaps, one myoc utaneous VRAM (vertical rectus abdominis muscle) free flap and one free rad ial forearm flap. None of our flaps failed. The complications that required revision (one arterial bleeding, one arterial thrombosis, two fistula form ations, one superficial wound dehiscence, one haematoma) occurred mainly in those patients having secondary reconstructions. After primary extensive o ncological resection of these tumours reconstruction should be done in one stage. The primary reconstruction should provide sufficient pharyngeal lini ng, a satisfactory covering of cervical soft-tissue, and adequate functiona l rehabilitation. We have reviewed our experience and conclusions about the advantages, disadvantages, and current indications for different free flap s in the reconstruction of combined hypopharyngeal, cervico-oesophageal, an d cervical skin defects.