Reconstruction of hypopharynx after pharyngolaryngectomy with U-shaped radial forearm flap

Background: After pharyngolaryngectomy reconstructive procedures of the upper digestive tract are necessary. Since the introduction of microvascular tissue transplantation jejunal loops prooved to be a versatile transplant. Nevertheless it has some disadvantages as i.e. the increased donor morbidity, a rather high sensitivity to hypoxia and the tendency of shrinkage and formation of stenosis. Method: We perform the reconstruction of the hypopharynx with the radial forearm flap. The fasciocutaneous flap is harvested on the radial artery in a size of 12 x 6 cm in average and is sutured U-shaped paramedian to the prevertebral fascia. In addition the posterior wail of the oesophagus and the oropharynx have to be adapted to the prevertebral fascia. Results: Between 1997 and 2001 we performed these reconstructions in 20 patients. In one case we found a complete flap necrosis, which required secondary reconstruction with a pectoralis major flap. In 2 patients we saw a stenosis at the junction to the oesophagus, which was treated by revision surgery and bougienage. In 18 patients swallowing was regular. 6 patients were able to learn oesophageal speech. Conclusion: The radial forearm flap in its U-shaped transposition to the prevertebral fascia represents a functionally good reconstructive procedure for the hypopharynx.