Deltopectoral flap reconstruction of the posterior pharyngeal wall -- a simple and functional solution to the reconstruction of circumferential laryngopharyngeal defects

Objectives To review the operative feasibility and functional outcomes following dual flap reconstruction of circumferential pharyngeal defects. Design Retrospective case series Setting University Hospital Monklands, a district general hospital Participants Eight patients undergoing either primary (n=5) or salvage (n=3) circumferential laryngopharyngectomy +/- cervical oesophagectomy, followed by dual flap reconstruction, with a deltopectoral flap to reconstruct the posterior wall. Main Outcome Measures Operative complications, hospital stay and functional outcomes (speech and swallowing) Results The operation was feasible in all patients, with dual flap reconstruction using a deltopectoral flap, combined with a pectoralis major flap (n=5) or a supraclavicular flap (n=3). All patients developed a small, lateralised, self-healing fistula at the site of the deltopectoral flap 3-point junction. This did not require any intervention, or impact on adjuvant treatment. Functional outcomes were favourable, with all patients achieving oral diet. One patient required gastrostomy diet supplementation, and one patient required stricture dilatation. Of the patients able to receive a speech valve (n=4), all achieved intelligible speech. Two patients could not receive a speech valve due to the inferior extent of the tumour resection, and trachea-oesophageal puncture has been delayed in 2 patients due to the COVID-19 pandemic. Conclusions Dual flap reconstruction of circumferential pharyngeal defects represents a simple, effective option for a complex reconstructive problem. The predictable operative recovery and favourable functional outcomes indicate that the use of both a deltopectoral flap and a second flap is a robust reconstructive solution.

Outcomes at 18 mo of 37 noma (cancrum oris) cases surgically treated at the Noma Children's Hospital, Sokoto, Nigeria

Background Noma is a rapidly progressing infection of the oral cavity frequently resulting in severe facial disfigurement. We present a case series of noma patients surgically treated in northwest Nigeria. Methods A retrospective analysis of routinely collected data (demographics, diagnosis and surgical procedures undergone) and in-person follow-up assessments (anthropometry, mouth opening and quality of life measurements) were conducted with patients who had surgery >6 mo prior to data collection. Results Of the 37 patients included, 21 (56.8%) were male and 22 (62.9%) were aged >6 y. The median number of months between last surgery and follow-up was 18 (IQR 13, 25) mo. At admission, the most severely affected anatomical area was the outer cheek (n = 9; 36.0% of patients had lost between 26% and 50%). The most frequent surgical procedures were the deltopectoral flap (n = 16; 43.2%) and trismus release (n = 12; 32.4%). For the eight trismus-release patients where mouth opening was documented at admission, all had a mouth opening of 0–20 mm at follow-up. All patients reported that the surgery had improved their quality of life. Conclusions Following their last surgical intervention, noma patients do experience some improvements in their quality of life, but debilitating long-term sequelae persist.