BACKGROUND: The reconstruction of extensive neck defects with minimum deformity and rapid return to normal food intake is successfully achieved by the use of gastro-omental flaps. We report a series of 18 patients who underwent such reconstructive surgery for major full-thickness defects involving the skin in addition to the larynx and pharynx. Fifteen patients had earlier undergone radiotherapy and 3 chemoradiotherapy; 14 of them had undergone previous surgery. The cause of the defect was tumor recurrence in 10 patients, a pharyngostoma in 6, and postoperative cellulitis in 2. PATIENTS AND METHODS: Harvesting of the flap included elevation of a segment of the greater curvature of the stomach together with the omentum pediculated on the right gastroepiploic vessels. In 8 patients with a circumferential pharyngeal defect, the graft was used in the form of a tube; in the other 10, the graft was converted into a patch to reconstruct the missing anterior pharyngeal wall. In all cases, the omentum was used to fill in the defect. In 5 patients, neck vessels were chosen as recipient vessels, and axillary vessel systems were selected in 13 because the surgical approach to neck vessels was contraindicated. RESULTS: There was no instance of total flap necrosis. Fifteen patients had an uneventful postoperative course, and oral food intake was begun on the 15th day. The remaining 3 patients developed fistulas, which healed spontaneously. The omentum was left to granulate in all patients, and skin grafts were required in 5 patients only. No abdominal complications occurred in any patients. CONCLUSIONS: These results suggest that gastro-omental free flaps are a method of choice that should be seriously considered for the reconstruction of full-thickness defects of the neck.
BACKGROUND: The reconstruction of extensive neck defects with minimum deformity and rapid return to normal food intake is successfully achieved by the use of gastro-omental flaps. We report a series of 18 patients who underwent such reconstructive surgery for major full-thickness defects involving the skin in addition to the larynx and pharynx. Fifteen patients had earlier undergone radiotherapy and 3 chemoradiotherapy; 14 of them had undergone previous surgery. The cause of the defect was tumor recurrence in 10 patients, a pharyngostoma in 6, and postoperative cellulitis in 2. PATIENTS AND METHODS: Harvesting of the flap included elevation of a segment of the greater curvature of the stomach together with the omentum pediculated on the right gastroepiploic vessels. In 8 patients with a circumferential pharyngeal defect, the graft was used in the form of a tube; in the other 10, the graft was converted into a patch to reconstruct the missing anterior pharyngeal wall. In all cases, the omentum was used to fill in the defect. In 5 patients, neck vessels were chosen as recipient vessels, and axillary vessel systems were selected in 13 because the surgical approach to neck vessels was contraindicated. RESULTS: There was no instance of total flap necrosis. Fifteen patients had an uneventful postoperative course, and oral food intake was begun on the 15th day. The remaining 3 patients developed fistulas, which healed spontaneously. The omentum was left to granulate in all patients, and skin grafts were required in 5 patients only. No abdominal complications occurred in any patients. CONCLUSIONS: These results suggest that gastro-omental free flaps are a method of choice that should be seriously considered for the reconstruction of full-thickness defects of the neck.
Authors: Christian A Righini; Georges Bettega; Thomas Lequeux; Philippe Chaffanjeon; Jacques Lebeau; Emile Reyt Journal: Eur Arch Otorhinolaryngol Date: 2004-09-07 Impact factor: 2.503