European Journal of Plastic Surgery

, Volume 41, Issue 2, pp 147–156 | Cite as

Microsurgical reconstruction of pharyngoesophageal defects—case series and critical review of the literature

  • Sara Cunha
  • Horácio Zenha
  • Diana Santos
  • Carolina Andresen
  • Tiago Guedes
  • Susana Graça
  • Carlos Soares
  • Antónia Póvoas
  • Jorge Maciel
  • Horácio Costa
Original Paper



The reconstructive goals after laryngopharyngoesophagectomy are the reestablishment of the digestive conduit, achievement of adequate swallowing, and voice restoration. The pharyngoesophageal segment is typically reconstructed with a jejunal or a fasciocutaneous free flap. The gastro-omental free flap offers unique advantages in high-risk surgical fields. The best reconstructive option is still a matter of controversy. A retrospective study was conducted to assess the morbidity and functional results of microsurgical pharyngoesophageal reconstructions performed at our institution in the last 16 years and compare them with the literature.


A retrospective review was conducted on patients who underwent pharyngoesophageal microsurgical reconstruction between 1999 and 2016 at a single institution. The perioperative morbidity, mortality, and functional outcomes were evaluated and compared with similar published case series.


A total of 14 free flap reconstructions were performed, after pharyngolaryngoesophagectomy or pharyngoesophageal radionecrosis. Patients received jejunal, radial forearm, gastro-omental, or anterolateral thigh flaps. There was one flap failure and one perioperative death. The rates of stricture and fistula were 8.3 and 16.7%, respectively. Oral diet was achieved in all patients and 71% have been considered to have an intelligible speech. At 1-year post-op, 71.4% of the patients were alive and the 3-year survival rate was 35.7%.


The reconstruction of the pharyngoesophageal segment requires safe, reliable, and functional single-stage solutions. Fasciocutaneous flaps seem to provide better functional results and allow a shorter hospital stay, while enteric flaps appear to be more reliable in adverse surgical fields.

Level of Evidence: Level IV, therapeutic study.


Pharyngoesophageal reconstruction Gastro-omental flap Salvage pharyngolaryngoesophagectomy Esophagus radionecrosis Jejunal flap Fasciocutaneous flaps 


Compliance with ethical standards


This study did not receive any funding.

Conflict of interest

Sara Cunha, Horácio Zenha, Diana Santos, Carolina Andresen, Tiago Guedes, Antónia Póvoa, Susana Graça, Carlos Soares, Jorge Maciel, and Horácio Costa declare that they have no conflict of interest.

Ethical approval

For this type of study, formal consent from an ethics committee is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.


  1. 1.
    Ho CM, Lam KH, Wie WI et al (1993) Squamous cell carcinoma of the hypopharyngx—analysis of treatment results. Head Neck 15:405–412CrossRefPubMedGoogle Scholar
  2. 2.
    Hui Y, Wei WI, Yuen PW et al (1996) Primary closure of pharyngeal remnant after total laryngectomy and partial phayngectomy: how much residual mucosa is sufficient? Laryngoscope 106:490–494CrossRefPubMedGoogle Scholar
  3. 3.
    Mikulicz J (1886) Ein Fall von Resection des Carcinomatosen Esophagus mit Plastischem Ersatz des Excidirten Stuckes. Prag Med Wchnschr 2:93Google Scholar
  4. 4.
    Wookey H (1948) The surgical treatment of carcinoma of the hypopharynx and the oesophagus. Br J Surg 35:249CrossRefPubMedGoogle Scholar
  5. 5.
    Wookey H (1942) The surgical treatment of carcinoma of the pharynx and upper esophagus. Surg Gynecol Obstet 75:499Google Scholar
  6. 6.
    Bakamjian VY (1965) A two-stage method for pharyngoesophageal reconstruction with a primary pectoral skin flap. Plast Reconstr Surg 36:173CrossRefPubMedGoogle Scholar
  7. 7.
    Ariyan S (1979) Further experiences with the pectoralis major myocutaneous flap for the immediate repair of defects from excisions of head and neck cancers. Plast Reconstr Surg 64:605–612CrossRefPubMedGoogle Scholar
  8. 8.
    Seidenberg B, Rosenak SS, Hurwitt ES et al (1959) Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment. Ann Surg 149:162–171CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Harii K, Ebihara S, Ono I et al (1985) Pharyngoesophageal reconstruction using a fabricated forearm free flap. Plast Reconstr Surg 75:463–476CrossRefPubMedGoogle Scholar
  10. 10.
    Kim K, Ibrahim AMS, Koolen PGL, Frankenthaler RA, Lin SJ (2014) Analysis of the NSQIP database in 676 patients undergoing laryngopharyngectomy: the impact of flap reconstruction. Otolaryngol Head Neck Surg 150(1):87–94CrossRefPubMedGoogle Scholar
  11. 11.
    Song YG, Chen GZ, Song YL (1984) The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg 37:149–159CrossRefPubMedGoogle Scholar
  12. 12.
    Baudet J (1979) Reconstruction of the pharyngeal wall by free transfer of the greater omentum and stomach. Int J Microsurg 1:53–59Google Scholar
  13. 13.
    Moran WJ, Panje WR (1987) The free greater omental flap for treatment of mandibular osteoradionecrosis. Arch Otolaryngol Head Neck Surg 113:425–427CrossRefPubMedGoogle Scholar
  14. 14.
    Righini CA, Betega G, Lequeux T, Chaffanjeon P et al (2005) Use of tubed gastro-omental free flap for hypopharynx and cervical esophagus reconstruction after total laryngo-pharyngectomy. Eur Arch Otorhinolaryngol 262:362–367CrossRefPubMedGoogle Scholar
  15. 15.
    Genden EM, Kaufman MR, Katz B et al (2001) Tubed gastro-omental free flap for pharyngoesophageal reconstruction. Arch Otolaryngol Head Neck Surg 127:847–853PubMedGoogle Scholar
  16. 16.
    Selber JC, Xue A, Liu J, Hanasono MM, Skoracki RJ, Chang EI, YU P (2014) Pharyngoesophageal reconstruction outcomes following 349 cases. J Reconstr Microsurg 30(9):641–654CrossRefPubMedGoogle Scholar
  17. 17.
    Shangold LM, Urken ML, Lawson W (1991) Jejunal transplantation for pharyngoesophageal reconstruction. Otolaryngol Clin N am 24:1321–1342Google Scholar
  18. 18.
    Murray DJ, Novak CB, Neligan PC (2008) Fasciocutaneous free flaps in pharingolaryngoesophageal reconstruction: a critical review of the literature. J Plast Reconstr Aesthet Surg 61:1148–1156CrossRefPubMedGoogle Scholar
  19. 19.
    Moiemen NS, Staiano JJ, Ojeh NO, Thway Y, Frame JD (2001 Jul) (2001). Reconstructive surgery with a dermal regeneration template: clinical and histological study. Plast Reconstr Surg 108(1):93–103CrossRefPubMedGoogle Scholar
  20. 20.
    Viñals JMV, Rodrigues TA et al (2014) Outcomes of gastro-omental free flap reconstruction of salvage laryngopharyngectomy for pharyngeal and laryngeal cancer after concurrent chemoradiotherapy. Ann Plast Surg. doi: 10.1097/SAP.0000000000000298
  21. 21.
    Yu P, Lewin JS, Reece GP, Robb GL (2006) Comparison of clinical and functional outcomes and hospital costs following pharyngoesophageal reconstruction with the anterolateral thigh free flap versus the jejunal flap. Plast Reconst Surg 117:968CrossRefPubMedGoogle Scholar
  22. 22.
    Clark JR, Gilbert R, Irish J, Brown D, Neligan P, Gullane PJ (2006) Morbidity after flap reconstruction of hypopharyngeal defects. Laryngoscope. doi: 10.1097/01.mlg.0000191459.40059.fd

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Department of Plastic, Reconstructive and Cranio-Maxillofacial Surgery and Microsurgery UnitCentro Hospitalar de Vila Nova de Gaia/Espinho E.P.EVila Nova de GaiaPortugal
  2. 2.Department of General SurgeryCentro Hospitalar de Vila Nova de Gaia/Espinho E.P.EVila Nova de GaiaPortugal
  3. 3.Head of DepartmentCentro Hospitalar de Vila Nova de Gaia/Espinho E.P.EVila Nova de GaiaPortugal

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