Scapular Free Flap Reconstruction Of Pharyngoesophageal Defects

Scapular and parascapular free tissue transfer (SFTT) is a well described reconstructive option for the head and neck. The aim of this study is to describe SFTT for reconstruction of PE (pharyngoesophagyeal) defects. This study was a retrospective review of patients undergoing SFTT for PE defects between 2009 and 2014 at a tertiary center. Seventeen patients (13 male and 4 female) were evaluated for surgical outcomes, speech, voice outcomes, swallowing outcomes, enteral feeding and tracheoesophageal puncture (TEP) usage. Two of 17 patients developed pharyngocutaneous fistulas (PCF) as inpatients. There was one major medical complication (pulmonary embolism) and 7 minor complications. Mean hospital length of stay was 15.7 days (SD 8.2). In post-operative setting, only one patient remained PEG-dependent, 11 patients supplemented oral intake with PEG feeds and 5 patients took nutrition solely by mouth. Four patients utilized written communication exclusively, 6 patients pursued TEP placement and 7 utilized electrolarynx. The SFTT is a viable option for hypopharyngeal reconstruction. All scapula free tissue transfers remained viable for the duration of our review. Post-operative PCF rate were comparable to that reported after laryngectomy.