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Kasey K. Li, DDS MD; Authur H. Salibian, MD; Glenn R. Allison, MD; Mark E. Krugman, MD; William Armstrong, MD; Brian Wong, MD; Timothy Kelly, MD

Arch Otolaryngol Head Neck Surg. 1998;124:1146-1151.

Objective  To evaluate the use of a generous fasciocutaneous ulnar forearm free flap in pharyngoesophageal reconstruction.

Design  Tertiary referral center.

Setting  Private practice.

Patients  From September 1, 1991, to October 30, 1996, 20 ulnar forearm free flaps were used to reconstruct the pharyngoesophagus in 19 patients after surgery for squamous cell carcinoma. There were 13 circumferential defects and 7 near-circumferential defects (<2 cm of mucosa remaining). The reconstructions were performed primarily (at the time of tumor resection) in 16 cases and secondarily in 4 cases.

Intervention  A generous fasciocutaneous ulnar forearm flap with a minimum dimension of 9x22 cm was harvested to reconstruct the pharyngoesophagus. A 2-layer closure was performed in flap tailoring and proximal (pharynx to flap) and distal (flap to esophagus) anastomoses to minimize the risk of leakage. Also, portions of the flap were used to monitor flap viability, to cover cervical vessels, to obliterate dead space, and as skin coverage when the skin flaps were deficient.

Results  Nineteen of the 20 flaps transferred were successful. Swallow function was restored in 18 cases, and voice was rehabilitated in all the patients using either tracheoesophageal puncture and a voice device or an electrolarynx device. There was 1 perioperative mortality. Three fistulas occurred, all of which healed with nonsurgical treatment. One stricture developed that required intermittent dilatation. The donor site morbidity was minor.

Conclusions  This versatile technique achieves excellent results with a decreased complication rate compared with other methods currently available in pharyngoesophageal reconstruction.

From the Department of Otolaryngology–Head and Neck Surgery (Drs Li, Allison, Krugman, Armstrong, Wong, and Kelly) and the Division of Plastic Surgery (Dr Salibian), Department of Surgery, University of California, Irvine, and the Center for Disorders of the Head and Neck–Western Medical Center (Drs Salibian, Allison, and Krugman), Santa Ana, Calif.

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