Evaluation of flaps following pharyngoesophageal reconstruction. (Esophagoscopy Clinic).

Koufman, James A.

We briefly report two cases in which transnasal esophagoscopy (TNE) was used to evaluate the status of pharyngoesophageal reconstruction following resection of a squamous cell carcinoma.

A 54-year-old man was evaluated for complaints of transient dysphagia. The dysphagia had begun 3 weeks after the patient had undergone resection of a squamous cell carcinoma that had involved approximately 70% of the luminal circumference at its distal extent. The resultant defect was reconstructed with a pectoralis major pedicled myocutaneous flap. TNE was employed to visualize the luminal surface of the flap, and it detected mild edema and redundancy with a well-epithelialized surface (figure, A).

The other patient, a 62-year-old man, underwent reconstruction of a similar defect via radial forearm free-tissue transfer. The flap was evaluated 4 days postoperatively by TNE because of excessive edema noted in the cervical skin flaps. Direct visualization of the luminal aspect of the flap revealed the presence of viable tissue and no evidence of ischemia or venous congestion; the suture lines at the anastomoses were intact (figure, B).

Modern reconstructive strategies for significant or complete circumferential pharyngoesophageal defects involve a variety of tissue-transfer techniques. Unless a portion of the flap can be externalized, these flaps are difficult or impossible to monitor postoperatively. TNE provides a safe and nonsedating method of directly observing the reconstructed area, even early in the postoperative period. TNE facilitates timely intervention in cases of falling flaps, and it can potentially avert unnecessary flap salvage procedures.

From the Center for Voice Disorders, Department of Otolaryngology, Wake Forest University Medical Center, Winston-Salem, N.C.; www.thevoicecenter.org