Pharyngoesophageal reconstruction with the ulnar forearm flap.

OBJECTIVE To evaluate the use of a generous fasciocutaneous ulnar forearm free flap in pharyngoesophageal reconstruction. DESIGN Tertiary referral center. SETTING Private practice. PATIENTS From September 1, 1991, to October 30, 1996, 20 ulnar forearm free flaps were used to reconstruct the pharyngoesophagus in 19 patients after surgery for squamous cell carcinoma. There were 13 circumferential defects and 7 near-circumferential defects (<2 cm of mucosa remaining). The reconstructions were performed primarily (at the time of tumor resection) in 16 cases and secondarily in 4 cases. INTERVENTION A generous fasciocutaneous ulnar forearm flap with a minimum dimension of 9 x 22 cm was harvested to reconstruct the pharyngoesophagus. A 2-layer closure was performed in flap tailoring and proximal (pharynx to flap) and distal (flap to esophagus) anastomoses to minimize the risk of leakage. Also, portions of the flap were used to monitor flap viability, to cover cervical vessels, to obliterate dead space, and as skin coverage when the skin flaps were deficient. RESULTS Nineteen of the 20 flaps transferred were successful. Swallow function was restored in 18 cases, and voice was rehabilitated in all the patients using either tracheoesophageal puncture and a voice device or an electrolarynx device. There was 1 perioperative mortality. Three fistulas occurred, all of which healed with nonsurgical treatment. One stricture developed that required intermittent dilatation. The donor site morbidity was minor. CONCLUSIONS This versatile technique achieves excellent results with a decreased complication rate compared with other methods currently available in pharyngoesophageal reconstruction.