Morbidity and functional outcomes following gastro-omental free flap reconstruction of circumferential pharyngeal defects.

Abstract

In patients with extensive soft tissue fibrosis requiring circumferential pharyngeal reconstruction following definitive radiotherapy and/or chemotherapy, we take advantage of abundant omental progenitor factors in the tubed gastro-omental free flap. This study reviews our experience with this flap. Review of 11 patients (median follow-up, 2.8 years) undergoing total pharyngolaryngectomy following organ preservation protocols for recurrent squamous cell carcinoma (n = 9) and stricture (n = 2). Operative morbidity and mortality rates were 54% and 9%, respectively. One patient died following carotid rupture. Complications included: chyle leak (18%), pharyngocutaneous fistula (9%), and late stricture (27%). Ten patients (91%) achieved oral diet, and all 7 patients (100%) considered suitable for tracheoesophageal speech rehabilitation achieved functional speech. Seven patients remain alive without disease at a median of 41 months following surgery. The gastro-omental flap provides a viable option in high-risk patients undergoing circumferential pharyngeal reconstruction.