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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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The study deals with the anatomy of the intermetacarpal cord artery and its branches and its involvement in the design of the dorsal metacarpal flap. The intermetacarpal artery originates from the deep palmar arch and supplies fingers. More specifically, it springs directly from the radial artery and gets divided into the arteries of the thumb and forefinger.

A flap is a vascularized tissue transfer to reconstruct a defect, and therefore every flap must have certain characteristics of size, function, circulation pattern, innervation, and so on. The metacarpal flap was described simultaneously by Maruyama and Quaba and there is controversy about whether to include the artery in the flap (Maruyama’s position) or not (Quaba). We have determined that it is not necessary to include the artery and Quaba design is therefore valid.

You can download and read the defense of the thesis which develops and supports this conclusion rigorously (available only in Spanish):

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