Reconstruction of the pharynx after resection for cancer. A comparison of methods.

Repair of the pharynx after extirpation of malignancy may require the introduction of independently vascularized tissue either at the time of resection (primary reconstruction) or later for undesirable sequelae, such as fistula or stenosis. A ten-year retrospective study compares two methods of pharyngeal reconstruction, the pectoralis major musculocutaneous flap (MCF) and the jejunal free autograft. One hundred and seventeen patients undergoing laryngopharyngectomy at Emory University affiliated hospitals between 1977 and 1987 were reconstructed with either the pectoralis major musculocutaneous flap (24 patients) or with the jejunal free autograft (93 patients) Primary repair with the pectoralis MCF was attempted on 12 patients (Group I) with initial success in 5 patients (42%), fistula in 7 patients (58%), and salvage surgery necessary in 6 patients (86%). Primary reconstruction with jejunal free autograft (Group II) was performed in 70 patients with 44 initial successes (63%), 9 graft failures (13%), 5 of which were salvaged by a second jejunal free autograft. Seventeen fistulas occurred (24%). Of these, nine (53%) closed with nonoperative therapy and five (29%) required surgery. Secondary reconstruction with the pectoralis major MCF was attempted in 12 patients with initial success in 3 patients (25%), and fistula in 9 patients (75%). Of these 9 fistula patients, 3 (33%) closed with nonoperative therapy and 6 required salvage surgery, which was successful in only 2 patients. Secondary repair with jejunal free autograft was performed in 23 patients with 13 (56%) initial successes and 8 patients resolving with nonoperative therapy (89%) for a total success rate of 21/23 or 91%. The higher initial success rates and more expeditious resolution of problems demonstrates that the jejunum is the superior method of reconstruction for the pharynx.