Functional Results of the Reconstruction of the Upper Digestive Tract by Visceral Flaps

we present our experience and evaluate of functional rehabilitation after surgical treatment of laryngeal and hypopharyngeal tumors using visceral flaps

Materials and methods: Since 1995 to 2018, the clinic has gained experience in reconstructing the pharynx and esophagus in 121 patients with malignant tumors. To optimize approaches to the selection of plastic material for reconstruction, we have developed a classification of pharyngeal defects after different laryngectomy modifications: type 0 - laryngectomy without tissue deficiency; type I - laryngectomy + tissue deficiency; type II - laryngectomy + partial hypopharynx defect; type III – laryngectomy + circular hypopharynx defect; type IV - laryngectomy + glossectomy; type V - laryngectomy + circular hypopharynx defect + extirpation of the esophagus. Taking into account the developed classification, an algorithm was developed for selecting a visceral flaps for reconstruction of the hypopharynx. Different variants of visceral flaps were used: gastro-omental flap – 46, colon-omental flap – 28, jejunum flap-21, omental flap – 5, ileocolon flap – 4. In 17 patients with the aim of total reconstruction of the hypopharynx and esophagus, transposition of the gastric pull-up, colon flap, jejunum flap and ileocolon flap.

Results: Follow up period was from 2 months to 16 years. Flap necrosis was noticed in 8,3%. Natural food intake was restored in 91,7%. Voice function was restored with voice prosthesis installation in 19 cases. Reconstruction with ileocolon free flap provides an opportunity of simultaneous tumor resection and free flap reconstruction with voice and nutrition functions restoration without voice prosthesis.

Conclusion: the use of a new classification of hypopharyngeal defects and an algorithm helps to optimize the choice of a suitable visceral flaps when restoring food-borne and voice functions, which leads to an improvement in the quality of life of patients and their early medical and social rehabilitation.