Esophageal Reconstruction With a Skin-Grafted Pectoralis Major Muscle Flap

Abstract

\s=b\Reconstruction of the cervical esophagus is a problem in the surgical treatment of hypopharyngeal cancer. The conventional deltopectoral skin flap and the pectoralis major myocutaneous flap both have shortcomings. We developed a new technique for the immediate reconstruction of the entire cervical esophagus that utilizes the pectoralis major muscle with skin grafted directly onto it. This is especially useful in female patients who are buxom or have thick subcutaneous adipose tissue, because the anterior chest skin is not used as the skin island and, therefore, the flap is not too bulky and cosmetic problems are minimal. The breast is left unaffected with the nipple in its normal position. We report the technical details and the results in four female patients with hypopharyngeal cancer.A combination of total laryngopharyngectomy and immediate reconstruction of the cervical esopha¬ gus is the operation of choice in the treatment of advanced hypopharyn¬ geal cancer. For the reconstruction, a staged technique with a deltopectoral skin flap1 has been widely adopted during the 1970s. In 1979, the pectoralis major myo¬ cutaneous flap2 was introduced in head and neck reconstructions and has proved particularly useful for this purpose.36 Total replacement can be accomplished in a single stage by i'jiterpositioning the tubed skin island, and this provides notable advantages over the deltopectoral skin flap facili-

Reconstruction of circumferential pharyngoesophageal defects with laryngotracheal flap and pectoralis major myocutaneous flap

“…However, the flap is bulky and difficult to tailor into a tube for reconstruction of circumferential defects of the PES. Although some modifications are made in tubed PMMCF, 8,9 the fistula and stricture rate are high, and long-term functional results are disappointing. 10 It seems that an increasing number of surgeons consider using free jejunal interposition as the first reconstruction option for pharyngoesophageal defects above the sternal notch.…”

The Pectoralis Major Myocutaneous Flap

“…29,30 To reduce the thickness of the flap, the pectoralis muscle may be raised without overlying fat and skin. 11,31,32 After it is secured in the recipient bed, a skin graft may be applied. However, concerning the bulkiness of the flap, a 50% reduction within 3 months is reported due to atrophy after division of the motor nerves.…”

One‐Stage Reconstruction of Partial Laryngopharyngeal Defects

“…The pectoralis major musculocutaneous flap has been extensively evaluated in head and neck pharyngeal reconstruction (see Table I) ( 19‐23 ). Attempts at reducing the bulk of this flap by using a muscle‐only split skin grafted flap while reducing bulk do so at the expense of suture line separation and late stenosis ( 24 ). Free flap reconstruction affords the perceived advantages of reduced bulk, tissue compliance, the potential of mucus secretion (jejunum), and sensate function (radial forearm).…”