Delayed reconstruction of pharyngeal and pharyngoesophageal defects in patients with malignant neoplasms of the larynx and pharyngeopharynx after laryngectomy. Review of the literature

Abstract

The aim of the study was to investigate the current surgical approaches and complications of delayed reconstruction of pharyngeal and pharyngoesophageal defects in patients with malignant neoplasms of the larynx and pharyngeopharynx after laryngectomy using different reconstructive materials. There are various classifications of pharyngoesophageal defects in the current literature, in which one should pay attention to the shape, size, and structure of the pharyngeal defect. The Blackwell and Urken classification is the most widely used in the choice of plastic material. The Blackwell and Urken classification distinguishes the following types of pharyngoesophageal defects: Type 0 - small defects that close mostly without tissue introduction; Type 1 - noncircular defects that retain a viable band of mucosa from the laryngeopharynx to the cervical esophagus; 2 type - circular defects that extend from the valleculae, that is, the depression between the root of the tongue and the lingual surface of the epiglottis, and down to the thoracic entrance; 3 type - circular defects that extend from the level of the valleculae and cranially to the oropharynx; 4 type - extensive defects that extend below the clavicles to the thoracic esophagus. The types of defects and types of plasty with the use of different plastic material depending on the type of defect are considered.
 In the delayed reconstruction of pharyngeal and pharygoesophageal defects in cancer patients various plastic materials are used: from the covering tissues, the material on the axial blood supply (deltopectoral, pectoral, thoracodorsal), free flaps (radial forearm flap, anterolateral thigh flap) and visceral flaps from fragments of the gastrointestinal tract, allowing to restore the integrity and lumen of the throat. At all types of plasty complications can develop in the postoperative period.