The fabricated radial forearm flap in pharyngolaryngeal surgery: saliva leakage and its prevention

Reconstruction of the circular pharyngo-oesophageal defect continues to represent a formidable challenge for the head and neck surgeon. The fabricated radial forearm flap can provide thin and pliable skin and has potential in this one-stage reconstructive surgery. However, major problems with this technique are saliva leakage, fistula formation and stricture of the oesophageal anastomosis. Our experience with this flap for 11 pharyngooesophageal reconstructions has given us a better understanding of how to prevent these complications. Fistula formation and stricture were problems in our first two cases. With the 9 following cases, prevention of these complications was achieved by positioning the T-shaped suture lines of the tubed flap posteriorly. Our results suggest that adequate protection of the T-shaped suture lines during fabrication and anastomosis of the forearm flap is important in the prevention of saliva leakage.