Reconstructive surgery: Pharingostome

The pharyngostomy is a reconstructive surgery process, not quite common but it happens. Spanish TV Channel “Cuatro” included us in a report we believe it might be of interest both to professionals and students, and patients affected by this problem. The quality of audio is not good for the first few minutes, then it gets fine and we apologize for it, but you still can follow the entire process smoothly.

The pharyngostome is an opening of the pharynx or cervical esophagus to the outside. When the patient eats, the food goes through the hole, preventing a proper nutrition while neck skin gets irritated. It usually occurs in patients who have undergone total laryngectomy for laryngeal cancer, usually following radiation therapy (though not always). It is complex to solve since saliva tends to digest sutures, it mobilizes the base of the tongue and pulls from the internal injuries, opening them.

We always have to try to close with healthy tissue. The chosen technique depends on the complexity of the hole. In small holes, just use local flaps of skin. When the defect is partial, locoregional flaps can be used as the supraclavicular or thoracoacromial or free flaps (microvascular anastomosis, which function as a transplant) like the one seen in this story (forearm, anterolateral thigh). In total and larger defects, it is better to perform a microvascular jejunal transplant (a fragment of jejunum is interposed between the pharynx and esophagus).

Usually the patient has to be with a gastrostomy feeding tube to prevent the passage of food. Also two or three weeks after the surgery until we are sure that the wound has closed and there are no leaks. Obviously the patient should be nutritionally correct (levels of albumin, total protein and blood are right).

In the case seen at the video, it was a recurrent situation, and it was very satisfying, although a slow and complex, to see we succeeded in solving the problem. I hope that Arturo is eating now all the salads he wants.

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1. 14 / Apr

   Antiaging Group BCN said…

   La Cuatro en el quirófano: cómo curar un faringostoma. El bueno de Arturo pudo comerse una tortilla al fin http://cot.ag/9WzSLT ^JBe

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