Optimizing Outcome of Pharyngoesophageal Reconstruction and Neck Resurfacing: 10-Year Experience Following 294 Cases
Basel Sharaf, MD, DDS1, Amy Xue, MD, DDS2, Mario Solari, MD3, Jun Liu, PhD4, Matthew Hanasono, MD4, Peirong Yu, MD4, Jesse Selber, MD, MPH4.
1Mayo Clinic, Rochester, MN, USA, 2Baylor College of Medicine, Houston, TX, USA, 3Department of Plastic Surgery University of Pittsburgh, Pittsburgh, PA, USA, 4MD Anderson Cancer Center, Houston, TX, USA.
PURPOSE:Pharyngoesophageal reconstruction is challenging. This series examines factors impacting the need for additional neck skin resurfacing and evaluates the impact of reconstructive modalities on outcomes.
METHODS: A review identified 294 patients who underwent pharyngoesophageal reconstruction from 2002 to 2012. Patients were divided based on neck skin resurfacing requirements. Patients undergoing neck resurfacing were further subdivided into reconstructive technique, including a second skin paddle or muscle component from the same free flap pedicle, a pectoralis major flap, or a second free flap. All groups were compared by co-morbidities, complications, and functional outcomes.
RESULTS: Of 294,179 patients (60.9%) required neck skin resurfacing. In the resurfaced group, there were 90 (50.3%) circumferential defects and 89 (49.7%) partial defects. In the resurfaced group, 110 (61.4%) were reconstructed with a second skin paddle from the same free flap pedicle, 21 (11.7%) were reconstructed with a muscle component from the same pedicle, and 25 (13.9%) received a pectoralis major flap. There were 5 external paddle flap losses in the resurfaced group (2.8%). There were no internal flap losses. Overall complications were similar among groups. The resurfaced group had a lower pharyngocutaneous fistula (PCF) rate (4.5%) compared to the primary closure group (11.3%, P=0.026). Prior neck surgery and radiation therapy were strong predictors of neck skin resurfacing (P<0.001). Tracheoesophageal speech quality and post-operative diet were similar.
CONCLUSION:Neck resurfacing is often required in pharyngoesophageal reconstruction. Providing additional vascularized tissue over the neo-conduit is predictive of lower PCF rates. An algorithmic approach is presented.
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