Reconstruction of laryngopharynx with pectoralis major myocutaneous flap

The advantage of the pectoralis major myocutaneous flap is that it can provide a large area of flaps in one stage, and the wounds after resection of laryngeal and pharyngeal carcinoma and cervical esophageal cancer are replenished. It has a rich blood supply and can also carry the attached ribs for bone. Transplantation, the donor site can be directly sutured, no need for skin grafting. Treatment of diseases: congenital esophageal atresia and esophageal cancer Indication 1. Reconstruction of laryngeal and cervical esophageal cancer after resection. 2. Traumatic or corrosive laryngeal, cervical esophageal defects or atresia. Preoperative preparation Preoperative fiber laryngoscopy, esophagoscopy, X-ray swallowing photos, CT scans, etc., should be used to estimate the extent of the donor site. Surgical procedure 1. The surgical method of resection of the neck according to the conventional hypopharyngeal and cervical esophageal cancer. The size of the defect after the resection was measured, and the area of the chest donor site was designed. 2. The design of the pectoralis major myocutaneous flap draws a vertical line along the midline of the clavicle, and then connects the shoulder to the xiphoid plane. The intersection of the two lines is the thoracic and acromical arteriovenous, and the inward and downward bends. The chest inside the nipple is on the line connecting the shoulder to the xiphoid. The size of the musculocutaneous flap is drawn according to the size of the donor skin, and the tail end is equal to or slightly longer than the midpoint of the affected area. The distance (Figure 1). 3. After cutting the skin of the flap, cut obliquely around the edge of the flap and extend it to the shoulder. When the length is 6-8 cm, the micro-bend is outward, and the subcutaneous tissue is separated to reach the surface of the pectoralis major. The outer edge of the pectoralis major muscle is separated, and the soft edge of the deep connective tissue is deeped by the fingers, and the blunt dissection is separated, and the thoracral aorta artery and its branches are searched upward. The blood vessel originates from the subclavian artery, and is about 2 to 4 cm in the middle of the clavicle. The shoulder and the xiphoid line are inclined downward to the inner side. The blood vessel bundle is preserved in the sarcolemma, and the fingers are separated deep in the muscle to avoid damage to the blood vessel. The muscle flap should be formed under the operation of protecting the blood vessel bundle after touching the blood vessel pulsation. Follow the skin incision in the lower part of the flap to cut the deep muscle 1 to 2 cm to the periphery, and suture the deep layer of the skin and the deep fascia (Fig. 2) to avoid separation of the skin from the muscles and fascia. 4. Cut off the attachment point of the pectoralis major and ribs, and lift the musculocutaneous flap (Fig. 3). When rib grafting is required, the fifth rib segment can be removed at the same time. The periosteum of the rib should be retained on the musculocutaneous flap. The two sides of the pectoralis major muscle are cut at appropriate points on both sides of the blood vessel, and are separated downward to the skin island to form an island flap of maximum mobility. 5. Make a subcutaneous tunnel between the chest and the neck. Through the tunnel, the island-shaped myocutaneous flap is transferred to the neck defect (Fig. 4), and the defect area after laryngeal and cervical esophagectomy is rectified. Although the wounds in the chest donor area are large, they can be sutured after being separated by subcutaneous sneak.