Simultaneous restoration of voice function and digestive tract continuity in patients with synchronous primaries of hypopharynx and thoracic esophagus with pedicled ileocolon flap

Background: Defects involving hypopharynx, cervical, and thoracic esophagus are challenging to reconstruct, and the available procedures usually leave patients voiceless. We describe our experience with a modified pedicled ileocolon flap for the reconstruction of alimentary conduit and voice in patients undergoing hypopharyngo-laryngectomy and total esophagectomy. Methods: Between January 1995 and December 2008, 7 patients underwent reconstruction of the digestive tract and voice function with a pedicled ileocolon flap because of extensive defects involving larynx, hyphopharynx, cervical, and thoracic esophagus. Patient's charts were reviewed and appropriate clinical data were evaluated. Results: All patients were male with a mean age of 58 years. The continuity of the digestive tract was restored with ileum-colon (n = 1) or colon (n = 6). The voice tube was reconstructed with appendix (n = 1) or with terminal ileum (n = 6). The middle colic artery (n = 1) and left ascending colic artery (n = 6) were used as a pedicle. Five flaps were supercharged using ileocolic vessels. All the flaps survived completely. No intraoperative or in-hospital mortalities occurred. The mean hospital stay was 40 days. The mean follow-up was 22.4 months. Two patients died of local recurrence (1 patient) and distant metastasis (1 patient). One patient died of the complications of pre-existing disease. At the last follow-up, the median deglutition score was 5/7. The median speech score for intelligibility and fluency was 3, and 4 for loudness. The maximum phonation time was 7.57 s. The average sound pressure loudness and fundamental frequency were, respectively, 59 ± 3 dB and 133 ± 33 Hz. Conclusion: The pedicled ileocolon flap as used in this series proved to be a safe and reliable technique for simultaneous reconstruction of voice and digestive tract.