Combined pectoralis flap and gastric pull-up for pharyngeal reconstruction.

Abstract

The gastric transposition flap, "gastric pull-up," is one of the standard techniques of reconstruction after total laryngopharyngectomy. Under certain circumstances, this method may provide insufficient tissue for a tension-free closure. In these circumstances, the surgeon could either close under tension, risking the viability of the flap and probable fistula; create a pharyngostome; or recruit additional tissue. In this article, we describe the use of the pectoralis major myocutaneous flap in combination with the gastric pull-up for reconstruction. A retrospective review of three patients who underwent the procedure was performed, and a detailed description of the surgical technique is provided. The procedure was performed in three patients, all of whom healed without wound infection or fistula. The combination of a pectoralis flap with a gastric transposition is an alternative for cases in which a gastric flap alone is insufficient. With this combination virtually any defect of the upper aerodigestive tract can be successfully closed.