Deltopectoral flap reconstruction of the posterior pharyngeal wall -- a simple and functional solution to the reconstruction of circumferential laryngopharyngeal defects

Objectives: To review the operative feasibility and functional outcomes following dual flap reconstruction of circumferential pharyngeal defects. Design Retrospective case series Setting University Hospital Monklands, a district general hospital Participants Eight patients undergoing either primary (n=5) or salvage (n=3) circumferential laryngopharyngectomy +/- cervical oesophagectomy, followed by dual flap reconstruction, with a deltopectoral flap to reconstruct the posterior wall. Main Outcome Measures Operative complications, hospital stay and functional outcomes (speech and swallowing) Results The operation was feasible in all patients, with dual flap reconstruction using a deltopectoral flap, combined with a pectoralis major flap (n=5) or a supraclavicular flap (n=3). All patients developed a small, lateralised, self-healing fistula at the site of the deltopectoral flap 3-point junction. This did not require any intervention, or impact on adjuvant treatment. Functional outcomes were favourable, with all patients achieving oral diet. One patient required gastrostomy diet supplementation, and one patient required stricture dilatation. Of the patients able to receive a speech valve (n=4), all achieved intelligible speech. Two patients could not receive a speech valve due to the inferior extent of the tumour resection, and trachea-oesophageal puncture has been delayed in 2 patients due to the COVID-19 pandemic. Conclusions Dual flap reconstruction of circumferential pharyngeal defects represents a simple, effective option for a complex reconstructive problem. The predictable operative recovery and favourable functional outcomes indicate that the use of both a deltopectoral flap and a second flap is a robust reconstructive solution.