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Hypopharyngeal reconstruction using remnant narrow pharyngeal wall as omega-shaped radial forearm free flap

 Jong Won Hong  ;  Hii Sun Jeong  ;  Dae Hyun Lew  ;  Tai Suk Roh  ;  Kwan Chul Tark  ;  Eun Chang Choi  ;  Won Jai Lee 
 JOURNAL OF CRANIOFACIAL SURGERY, Vol.20(5) : 1334-1340, 2009 
Journal Title
Issue Date
Anastomosis, Surgical/methods ; Constriction, Pathologic/etiology ; Deglutition Disorders/etiology ; Diet ; Follow-Up Studies ; Forearm/surgery ; Graft Survival ; Humans ; Hypopharyngeal Neoplasms/surgery ; Hypopharynx/pathology ; Hypopharynx/surgery* ; Jejunum/transplantation ; Laryngectomy/classification ; Oral Fistula/etiology ; Pectoralis Muscles/transplantation ; Pharyngeal Diseases/etiology ; Pharyngectomy/classification* ; Pharynx/pathology ; Pharynx/surgery* ; Postoperative Complications ; Radius ; Reconstructive Surgical Procedures/methods* ; Retrospective Studies ; Surgical Flaps/classification* ; Tissue and Organ Harvesting/methods ; Treatment Outcome
Omega-shaped RFFF ; hypopharyngeal reconstruction ; remnant hypopharyngeal wall
PURPOSE: There have been numerous attempts to use pharyngoesophageal reconstruction to restore swallowing function. Much controversy exist over reconstruction after total or partial pharyngectomy, and there is also debate over whether to continue with the reconstructive procedure with a narrow strip of remnant mucosa or complete it after total pharyngectomy. We analyzed the utility of omega-shaped radial forearm free flap (RFFF) using the narrow remnant posterior pharyngeal wall.

METHODS: Patients in group 1 (n = 12) had a narrow remnant pharyngeal wall with a width of less than 3 cm. Those in group 2 (n = 35) had a remnant pharynx with a width larger than 3 cm. The incidence of fistula, stricture, and swallowing difficulty were evaluated. Swallowing difficulty was graded using a 7-point visual analog scale. All circumferential hypopharyngeal reconstruction with tubed RFFF, pectoralis major flap, and jejunal free flap were also compared with group 1.

RESULTS: All flaps survived, and 1 fistula (8%) was detected in group 1. Compared with tubed RFFF (46%) and tubed pectoralis major flap (57%), this is a relatively low rate of fistula formation. In group 1, normal diet was possible in 92% of patients, but 1 patient can tolerate a liquid diet only. In group 2, normal diet was possible in 80% of patients. As for swallowing difficulty, the median visual analog scale score for both groups 1 and 2 was 6 points. When comparing different flaps, stricture and fistula rate was 0 and 8% in group 1, 15 and 46% in tubed RFFF, 43 and 57% in tubed pectoralis major flap, and 33 and 5% in jejunal flap, respectively.

CONCLUSIONS: We performed all surgeries taking care not to transgress the wide excision principle with the remnant hypopharyngeal wall. For remnant lesions greater than 3 cm, patch-type RFFF was performed, whereas for those less than 3 cm, omega-shaped RFFF was done. We achieved fairly good results in both groups without total resection of the narrow remnant hypopharyngeal wall
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1. College of Medicine (의과대학) > Dept. of Otorhinolaryngology (이비인후과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Plastic and Reconstructive Surgery (성형외과학교실) > 1. Journal Papers
Yonsei Authors
Roh, Tai Suk(노태석) ORCID logo https://orcid.org/0000-0001-8681-159X
Lew, Dae Hyun(유대현)
Lee, Won Jai(이원재) ORCID logo https://orcid.org/0000-0003-3056-0503
Jeong, Hii Sun(정희선)
Choi, Eun Chang(최은창)
Tark, Kwan Chul(탁관철)
Hong, Jong Won(홍종원) ORCID logo https://orcid.org/0000-0002-7762-0940
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