Island pectoralis major myocutaneous flap for pharyngo-oesophageal strictures prior to oesphagocoloplasty

Pharyngo-oesophageal strictures are not uncommon in corrosive injuries eith er alone or in association with dense strictures further down the oesophagu s. Strictures at the pharyngo-oesophageal junction require preliminary corr ection prior to oesophageal bypass since surgical bypass to the pharynx abo ve the cricopharyngeal junction is associated with risk of aspiration. A on e stage island pectoralis major myocutaneous flap has been used in four pat ients who had a non-dilatable dense cricopharyngeal stricture leading to a segment of near normal oesophagus followed by dense stricturing of the thor acic oesophagus. This procedure was followed by oesphagocolic bypass at a s econd stage from the cervical oesophagus to the stomach. The preliminary pe ctoralis major flap correction avoids problems such as aspiration or chokin g associated with pharyngo-colic anastomosis for oesophageal bypass. All fo ur patients had uncomplicated healing. Post-operative endoscopy showed easy passage through the cricopharynx with a dilated cervical oesophagus partly lined by skin. Normal swallowing was restored by a second stage oesphago-c olic bypass 6 weeks after the pectoralis major flap repair in two patients while the other two are awaiting the second stage. Island pectoralis major myocutaneous flap is simple, has a dependable vascularity and offers one st age correction for isolated cricopharyngeal corrosive stricture. It can als o be used prior to oesophago colic bypass in patients who have further stri ctures in the thoracic oesophagus.