Island pectoralis major myocutaneous flap for pharyngo-oesophageal strictures prior to oesphagocoloplasty

• Published in: Journal of the Royal College of Surgeons of Edinburgh Vol. 46; no. 4; pp. 202 - 204
• Main Authors: ANANTHAKRISHNAN, N, NACHIAPPAN, M, SUBBA RAO, K. S. V. K
• Format: Journal Article
• Language: English
• Published: Edinburgh Royal College of Surgeons of Edinburgh 01.08.2001
• Subjects: Anastomosis, Surgical - methods; Biological and medical sciences; Caustics - adverse effects; Colon - surgery; Digestive System Surgical Procedures - methods; Esophageal Stenosis - chemically induced; Esophageal Stenosis - diagnostic imaging; Esophageal Stenosis - surgery; Esophagus; Esophagus - surgery; Female; Follow-Up Studies; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Humans; Injury Severity Score; Male; Medical sciences; Pectoralis Muscles - transplantation; Pharyngeal Diseases - chemically induced; Pharyngeal Diseases - diagnostic imaging; Pharyngeal Diseases - surgery; Preoperative Care; Radiography; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Surgery of the upper aerodigestive tract; Surgical Flaps; Treatment Outcome; Human; Corrective surgery; Esophageal disease; Stenosis; Pectoralis major muscle; Trauma; Surgery; Digestive diseases; ENT disease; Adult; Pharynx disease; Junction; Technique; Flap (surgery); Pharyngoesophageal
• ISSN: 0035-8835; 1365-2877

Pharyngo-oesophageal strictures are not uncommon in corrosive injuries either alone or in association with dense strictures further down the oesophagus. Strictures at the pharyngo-oesophageal junction require preliminary correction prior to oesophageal bypass since surgical bypass to the pharynx above the cricopharyngeal junction is associated with risk of aspiration. A one stage island pectoralis major myocutaneous flap has been used in four patients who had a non-dilatable dense cricopharyngeal stricture leading to a segment of near normal oesophagus followed by dense stricturing of the thoracic oesophagus. This procedure was followed by oesphagocolic bypass at a second stage from the cervical oesophagus to the stomach. The preliminary pectoralis major flap correction avoids problems such as aspiration or choking associated with pharyngo-colic anastomosis for oesophageal bypass. All four patients had uncomplicated healing. Post-operative endoscopy showed easy passage through the cricopharynx with a dilated cervical oesophagus partly lined by skin. Normal swallowing was restored by a second stage oesphago-colic bypass 6 weeks after the pectoralis major flap repair in two patients while the other two are awaiting the second stage. Island pectoralis major myocutaneous flap is simple, has a dependable vascularity and offers one stage correction for isolated cricopharyngeal corrosive stricture. It can also be used prior to oesophagocolic bypass in patients who have further strictures in the thoracic oesophagus.