Ileocolic free flap for voice and swallowing rehabilitation after pharyngolaryngo-esophagectomy: a preliminary report

Abstract 

The usual approach for patients with advanced hypopharyngeal cancer is a multimodal treatment with surgical resection and radiation therapy. A circular pharyngolaryngoesophagectomy is mandatory in cases with advanced disease, even if it extends above the upper esophageal sphincter, followed by an immediate reconstruction. A microsurgical reconstructive technique is advised, based on Kawahara’s technique, using an ileocolic free flap as a single stage procedure for voice and swallowing rehabilitation. A total of four patients with advanced squamous cell carcinoma of the oropharynx was submitted to surgery. After pharyngolaryngoesophagectomy, the ileocolic complex was transposed and revascularized in the cervical field; the digestive tract restoration was performed with the cecum and ascending colon, while the last ileal loop was anastomosed to the cervical trachea. The continence mechanism of the ileocecal valve was used to protect the airways from inhalation of food and saliva and to obtain a monotonic phonation. A tracheal stoma was maintained to permit satisfactory breathing. All patients underwent this procedure successfully, with recovery of swallowing function and vocal performance within a short time, varying from 18 to 38 days.