Pharyngoesophageal Reconstruction Using the Radial Forearm Fasciocutaneous Free Flap: Preliminary Results

Abstract

Pharyngoesophageal reconstruction remains a challenge to the head and neck surgeon. The goals of pharyngoesophageal reconstruction include restoration, with minimal morbidity, of a person's ability to swallow and to speak. Myocutaneous flaps, gastric pull-up, and the jejunal free flap are popular methods of pharyngoesophageal reconstruction; however, none of these modalities is clearly ideal. We have begun utilizing the radial forearm fasciocutaneous free flap for pharyngoesophageal reconstruction. Twelve patients have had reconstruction with this flap with follow-up from 2 to 15 months. Seven defects were circumferential, and five were noncircumferential. Ten patients (83%) have had successful restoration of both swallowing ability and voice. Donor site morbidity was minimal. The leading complication was salivary leak, which was present in eight (67%) patients. Five of the leaks closed with nonsurgical intervention. No cases of flap necrosis occurred. The radial forearm free flap is a thin and pliable flap that closely approximates the tissue consistency of normal pharynx. Successful restoration of a patient's ability to swallow approximates that of enteral flaps and is superior to that of MC flaps. Successful speech restoration is superior to that of enteral and MC flaps. Donor site morbidity is less than that caused by enteral flaps because laparotomy is avoided. Salivary leak is higher than with enteral flaps. Part of this difference is accountable to the high number of secondary and technically challenging reconstructions in this series, and we have taken steps to lower this rate of leakage. These preliminary data show that the radial forearm fasciocutaneous free flap is well suited for pharyngoesophageal reconstruction. Additional experience with this flap for pharyngoesophageal reconstruction is necessary to fully evaluate its utility.