Options for reconstruction of the pharyngoesophageal defect.

Reconstruction of the circumferential pharyngoesophageal defect and functional rehabilitation of swallowing after cancer ablation remain a challenge for head and neck surgeons. A variety of techniques have been described, four of which have particular merit. The following general guidelines can be utilized when selecting a reconstructive technique. The pectoralis major myocutaneous flap can be used when pharyngeal mucosa remains following cancer resection or by surgeons who do not perform microvascular free tissue transfer to reconstruct circumferential defects. Gastric pull-up should be used if significant extension of tumor into the esophagus is present, oncologically necessitating esophagectomy. Free jejunal flaps are particularly useful in obese patients or patients in whom the lateral cutaneous thigh flap is otherwise contraindicated. The lateral thigh flap gives excellent results, has low morbidity, and causes virtually no functional impairment at the donor site. We believe that it represents state of the art in pharyngoesophageal reconstruction.