Objective: To explore the principles of donor site selection for defects of the hypopharynx and/or cervical-esophagus based on a novel defect classification system and treatment outcome of this series.
Method: Thirty-nine patients underwent reconstruction of their defects of the hypopharynx and/or cervical-esophagus from January 2007 to June 2012 were retrospectively studied. 23 hypopharngeal and/or cervical-esophageal defects were circumferential or near circumferential (group A), 16 were partial(group B). 22 patients had compromised neck vascular status, while the other 17 patients had normal neck vascular status. Selection of the donor sites was based on extent of the defects and neck vascular status. Donor sites for reconstruction of the defects of group A included anterolateral thigh flap (n = 8), gastric pull-up (n = 6), radial forearm flap (n = 3), jejunum flap (n = 3), and pectoralis major myocutaneous flap (n = 3). For goup B, Infrahyoid myocutaceous flaps, radial forearm flaps, and pectoralis major myocutaneous flaps were used in 8, 3, and 5 cases, respectively. Flap survival, surgical complications, function outcome, and tumor control were observed.
Result: Overall complication rate was 12.8% (5/39) in this series. In group A, three flap necroses occurred in jejunum flap (n = 1), anterolateral thigh flap (n = 1), and pectoralis major flap (n = 1). All these flap necroses occurred in the compromised neck vascular status group. One case of pharyngeal fistula without flap necrosis occurred in Group B. All except 2 patients restored oral intake postoperatively; 16 patients with laryngeal preservation had good phonation postoperatively. 2-year and 3-year survival of this series were 72.1% and 65.2%, respectively.
Conclusion: Selection of an appropriate donor site for reconstruction of the defects of hypopharynx and /or cervical-esophagus should be based on the extent of the defects, neck vascular status, and clinical features of the flap. Individualized donor site selection for hypopharyngeal and cervical esophageal defects reconstruction can result in good clinical outcome.