Partial Laryngopharyngectomy

Total laryngectomy and partial hypopharyngectomy are common defects most often resulting from resection of a laryngeal tumor that has spread to a piriform sinus. The remaining pharynx usually consists of a vertically oriented remnant extending from the base of tongue (oropharynx) to the cricopharyngeus (Fig. 20). If this posterior hypopharyngeal remnant cannot be closed primarily, pharyngeal reconstruction using flap tissue is needed. An adequate amount of pharyngeal mucosa is characterized by its ability to allow primary closure with a continuous vertically oriented suture line around a #8 endotracheal tube without tension. As with all mucosal

Figure 21 Pectoralis myocutaneous flap being sutured to the posterior pharyngeal remnant to form a complete tube.

suturing techniques in the pharynx, inverting (interrupted) absorbable sutures (Vicryl or polydioxanone suture on a tapering needle) are used to achieve a watertight closure. There is no serosa associated with the pharyngeal mucosa, so a second layer of constrictor muscle over the suture line is useful. If the posterior remnant is deemed inadequate to form a suitable tube for swallowing then a soft tissue flap is needed. The flap of choice in this circumstance is the pectoralis major myocutaneous flap because of its reliability, availability, and ease of harvest. Although the flap does not easily form a tube on itself, it is adequate to create a partial tubular form with the posterior wall consisting of the existing pharyngeal strip (Fig. 21). The posterior remnant provides adequate elasticity for unimpeded food bolus transit to the esophagus. It makes little difference which regional or free cutaneous flap is used, as long as the anterior wall is replaced with well-vascularized skin to achieve a watertight seal. In patients with a hirsute chest or in women an alternative to the pectoralis flap may be chosen.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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