Deltopectoral flap reconstruction of the posterior pharyngeal wall -- a
simple and functional solution to the reconstruction of circumferential
laryngopharyngeal defects
Abstract
Objectives To review the operative feasibility and functional outcomes
following dual flap reconstruction of circumferential pharyngeal
defects. Design Retrospective case series Setting University Hospital
Monklands, a district general hospital Participants Eight patients
undergoing either primary (n=5) or salvage (n=3) circumferential
laryngopharyngectomy +/- cervical oesophagectomy, followed by dual flap
reconstruction, with a deltopectoral flap to reconstruct the posterior
wall. Main Outcome Measures Operative complications, hospital stay and
functional outcomes (speech and swallowing) Results The operation was
feasible in all patients, with dual flap reconstruction using a
deltopectoral flap, combined with a pectoralis major flap (n=5) or a
supraclavicular flap (n=3). All patients developed a small, lateralised,
self-healing fistula at the site of the deltopectoral flap 3-point
junction. This did not require any intervention, or impact on adjuvant
treatment. Functional outcomes were favourable, with all patients
achieving oral diet. One patient required gastrostomy diet
supplementation, and one patient required stricture dilatation. Of the
patients able to receive a speech valve (n=4), all achieved intelligible
speech. Two patients could not receive a speech valve due to the
inferior extent of the tumour resection, and trachea-oesophageal
puncture has been delayed in 2 patients due to the COVID-19 pandemic.
Conclusions Dual flap reconstruction of circumferential pharyngeal
defects represents a simple, effective option for a complex
reconstructive problem. The predictable operative recovery and
favourable functional outcomes indicate that the use of both a
deltopectoral flap and a second flap is a robust reconstructive
solution.