Free gastro-omental flap reconstruction of the complex, irradiated pharyngeal wound

Background. Reconstruction of the complex pharyngeal wound after radiotherapy presents a surgical challenge. Methods. Evaluation of the gastro-omental flap in the reconstruction of the pharynx and overlying soft tissue after local flap failure. Results. A 70-year-old patient underwent a total laryngectomy and radical neck dissection after 70 Gy of external beam radiotherapy for an advanced squamous cell carcinoma of the pyriform sinus. Postoperatively, a large pharyngocutaneous fistula developed. Attempted closure with a pectoralis major flap was unsuccessful. A tubed gastro-omental free flap based on the right gastroepiploic vessels was used to reconstruct the pharynx. The accompanying greater omentum was skin grafted after filling the large soft tissue defect in the neck. The wounds healed primarily, and oral alimentation was resumed on the seventh postoperative day. Conclusions. The gastro-omental flap is a versatile composite flap which can provide mucosal lining as well as abundant soft tissue. It should be considered a secondary option in irradiated, complex pharyngeal wounds when local flaps are not available to be used in conjunction with free jujunal transfer. (C) 1997 John Wiley & Sons, Inc.