The pectoralis myofascial flap in pharyngolaryngeal surgery after radiotherapy

Complications with forehead flaps in nasal reconstruction

OBJECTIVES/HYPOTHESIS

To determine what characteristics and comorbidities are associated with a higher rate of complications in patients undergoing nasal reconstruction with a forehead flap.

STUDY DESIGN

Retrospective chart review.

METHODS

Chart review was completed on all patients undergoing nasal reconstruction with forehead flap from 1995 to 2008. Three pre-existing comorbidities were tracked: diabetes, smoking, and vascular disease. Major complications (flap necrosis, nasal obstruction, alar notching) and minor adverse outcomes (partial nasal obstruction, epidermolysis, and alar asymmetry) were recorded.

RESULTS

Two hundred five patients with a median age of 66 years had forehead flap reconstruction between October 1995 and July 2008. Sixty-two patients (30.2%) had full-thickness defects. Forty-eight patients (23.4%) were smokers, 17 (8.3%) were diabetics, and 90 (43.9%) fell into our category of vascular disease. Thirty-three (16.1%) developed a major complication at some point in their postoperative course, with 11 (5.4%) having some degree of flap necrosis, 10 (4.9%) nasal obstruction, and 20 (9.8%) alar notching. Full-thickness defects were significantly associated with higher incidences of any major complication, and had higher odds of flap necrosis and alar notching. Smokers had higher odds of developing flap necrosis. Neither the presence of diabetes, increased age, nor vascular disease was significantly associated with higher rates of major complications.

CONCLUSIONS

Smokers with full-thickness defects are shown to be at greater odds for developing a postoperative complication. Laryngoscope, 2009.

Re-use of pectoralis major myocutaneous flap for the treatment of recurrent hypopharyngeal stenosis following total laryngectomy and postoperative radiotherapy: a case report

Management of recurrent hypopharyngeal stenosis following total laryngectomy and postoperative radiotherapy is a challenging problem. Because of previous surgery, free flaps may not always be performed. We report a case of recurrent hypopharyngeal stenosis after a first attempt of reconstruction with a pectoralis major myocutaneous pedicled flap (PMMPF) failed. The problem was solved by reusing the previous PMMPF as a rotary door flap according to Eliachar and suturing it to the prevertrebral fascia according to Spriano. The follow-up is now of 9 months without recurrence. This new technique is described and discussed in comparison with other possible options.