Hypopharyngeal, esophageal, and neck reconstruction

Hypopharyngeal, esophageal, and neck reconstruction is one of most challenging reconstructive dilemmas that demands extensive planning, meticulous surgical execution, and timely management of postoperative complications. The ultimate goals of pharyngoesophageal reconstruction are to protect critical blood vessels of the neck, to provide alimentary continuity, and to restore functions such as speech and swallowing. However, reconstruction is extremely challenging as most patients have received radiation preoperatively. The anterolateral thigh flap has become the workhorse flap for this type of reconstruction. Many patients with pharyngoesophageal defects present with a frozen neck due to previous radiotherapy and surgery, making reconstruction extremely difficult with high surgical risks. Therefore, meticulous planning, use of transverse cervical vessels as recipient vessels, and a two-skin island anterolateral thigh flap to simultaneously resurface the neck for a through-and-through defect can simplify the procedure and reduce surgical risks. While major complications following pharyngoesophageal reconstruction include anastomotic strictures and fistulas, most patients can eat an oral diet after reconstruction without the need for tube feeding. In addition, fluent speech can be achieved in greater than 80% of patients after speech rehabilitation with tracheoesophageal puncture.