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Microsurgical reconstruction of pharyngoesophageal defects—case series and critical review of the literature

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

The reconstructive goals after laryngopharyngoesophagectomy are the reestablishment of the digestive conduit, achievement of adequate swallowing, and voice restoration. The pharyngoesophageal segment is typically reconstructed with a jejunal or a fasciocutaneous free flap. The gastro-omental free flap offers unique advantages in high-risk surgical fields. The best reconstructive option is still a matter of controversy. A retrospective study was conducted to assess the morbidity and functional results of microsurgical pharyngoesophageal reconstructions performed at our institution in the last 16 years and compare them with the literature.

Methods

A retrospective review was conducted on patients who underwent pharyngoesophageal microsurgical reconstruction between 1999 and 2016 at a single institution. The perioperative morbidity, mortality, and functional outcomes were evaluated and compared with similar published case series.

Results

A total of 14 free flap reconstructions were performed, after pharyngolaryngoesophagectomy or pharyngoesophageal radionecrosis. Patients received jejunal, radial forearm, gastro-omental, or anterolateral thigh flaps. There was one flap failure and one perioperative death. The rates of stricture and fistula were 8.3 and 16.7%, respectively. Oral diet was achieved in all patients and 71% have been considered to have an intelligible speech. At 1-year post-op, 71.4% of the patients were alive and the 3-year survival rate was 35.7%.

Conclusions

The reconstruction of the pharyngoesophageal segment requires safe, reliable, and functional single-stage solutions. Fasciocutaneous flaps seem to provide better functional results and allow a shorter hospital stay, while enteric flaps appear to be more reliable in adverse surgical fields.

Level of Evidence: Level IV, therapeutic study.

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Authors and Affiliations

  1. Department of Plastic, Reconstructive and Cranio-Maxillofacial Surgery and Microsurgery Unit, Centro Hospitalar de Vila Nova de Gaia/Espinho E.P.E, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal

    Sara Cunha, Horácio Zenha, Diana Santos, Carolina Andresen, Tiago Guedes & Horácio Costa

  2. Department of General Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho E.P.E, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal

    Susana Graça, Carlos Soares, Antónia Póvoas & Jorge Maciel

  3. Head of Department, Centro Hospitalar de Vila Nova de Gaia/Espinho E.P.E, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal

    Jorge Maciel & Horácio Costa

Authors
  1. Sara Cunha
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  2. Horácio Zenha
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  3. Diana Santos
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  4. Carolina Andresen
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  5. Tiago Guedes
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  6. Susana Graça
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  7. Carlos Soares
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  8. Antónia Póvoas
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  9. Jorge Maciel
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  10. Horácio Costa
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Corresponding author

Correspondence to Sara Cunha.

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Funding

This study did not receive any funding.

Conflict of interest

Sara Cunha, Horácio Zenha, Diana Santos, Carolina Andresen, Tiago Guedes, Antónia Póvoa, Susana Graça, Carlos Soares, Jorge Maciel, and Horácio Costa declare that they have no conflict of interest.

Ethical approval

For this type of study, formal consent from an ethics committee is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Cunha, S., Zenha, H., Santos, D. et al. Microsurgical reconstruction of pharyngoesophageal defects—case series and critical review of the literature. Eur J Plast Surg 41, 147–156 (2018). https://doi.org/10.1007/s00238-017-1335-6

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  • DOI: https://doi.org/10.1007/s00238-017-1335-6

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