The lateral island trapezius myocutaneous flap for circumferential reconstruction of hypopharynx and cervical esophagus

The lateral island trapezius was utilized for reconstruction of hypopharyng eal and cervical esophagus defects in high-risk patients, avoiding entry in to the celomic cavities as an approach to decrease morbidity and mortality. Seven male patients were treated at the State University of New York betwe en 1988 and 1991 and underwent reconstruction with the lateral island trape zius flap. There was no mortality, 2 patients developed pharyngocutaneous f istulas; 1 patient operated after radiation treatment failure remained with positive margins at resection but his fistula never healed, and another pa tient underwent a minor revision with successful closure of the fistula. Al l patients regained swallowing and none required dilatations. The preferred methods of reconstruction for the reasonable risk patient are gastric pull -up and free jejunal transfer; both of which require entry into cavities. T he lateral island is a reliable alternate method of reconstruction for high -risk patients in whom intracavitary surgery may lead to unacceptably high morbidity and mortality. When the vascular anatomy is not favorable, rerout ing of the vessels may be required utilizing microvascular reconstruction. The donor site defect is closed primarily or skin grafted, and subsequent f unctional limitations are minimal and well tolerated. Copyright (C) 2001 S. Karger AG, Basel.