Radial forearm free flap pharyngoesophageal reconstruction

Objectives: This study evaluates the outcome of pharyngoesophageal reconstr uction using radial forearm free flaps with regard to primary wound healing , speech, and swallowing in patients requiring laryngopharyngectomy. Study Design: Retrospective review in the setting of a tertiary, referral, and ac ademic center. Patients and Methods: Twenty patients underwent reconstructi on of the pharyngoesophageal segment using fasciocutaneous radial forearm f ree Baps. Results: Ah free flap transfers were successful. An oral diet was resumed in 85% of the patients after surgery. Postoperative pharyngocutane ous fistulas occurred in 4 patients (20%) with 3 resolving spontaneously. D istal strictures also occurred in 20% of the patients. Five patients who un derwent tracheoesophageal puncture achieved useful speech. Conclusions: Adv antages of radial forearm free flaps for microvascular pharyngoesophageal f unction include high flap reliability, limited donor site morbidity, larger vascular pedicle caliber, and the ability to achieve good quality tracheoe sophageal speech. The swallowing outcome is similar to that achieved after jejunal flap pharyngoesophageal reconstruction. The main disadvantage of th is technique relates to a moderately high incidence of pharyngocutaneous fi stulas, which contributes to delayed oral intake in affected patients.