case_images: PMC11346689_01
case_images: Hypopharyngeal defect with an esophageal stoma and permeable tracheostomy
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case_images: PMC11346689_01_wjps-13-077-g001.jpg
case_images: F1
case_images: In the year of 2023 upon admission, the physical examination revealed a 20.3 BMI, permeable tracheostomy, a skin defect of 10 x 8 cm, a hypopharynx defect of 3 x 3 cm and an esophageal defect of 3 x 3 cm, with perilesional maceration and significant fibrosis (Figure 1).
case_images: Surgical sequence (A) left cervical dissection at recipient site, (B) tubed right radial forearm free flap design (C) tubed free flap placement
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case_images: F2
case_images: During the procedure, the absence of the left internal jugular vein was found, the left superior thyroid artery and lingual artery were dissected, as well as the external jugular vein and the posterior edges of the hypopharynx were dissected (Figure 2A), ischemia of the right thoracic limb began and a 10 x 10 cm radial forearm flap was designed, the radial artery was dissected distally and subsequently between the brachioradialis and the flexor carpi radialis. The radial vessels were proximally referred, proximal and distal vessels were ligated (Figure 2B). End-to-end anastomosis of the radial artery and vein to the facial artery and vein respectively was performed with 9-0 nylon suture, adequate patency and integrity of anastomosis was confirmed (Figure 2C).
case_images: (A) Immediate post op, (B) 3 months post op, (C) 12 months post op
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case_images: PMC11346689_01_wjps-13-077-g003.jpg
case_images: F3
case_images: Subsequently, the previously designed flap was placed and fixed with 4-0 monocryl for the posterior wall, and 3-0 nylon for the anterior wall to offer skin coverage (Figure 3A). The patient progressed to semi-solids and solid food at home, gaining 20 kg with subsequent removal of the gastrostomy tube (Figure 3B). Eighteen months after his surgery, he continues tolerating oral intake without signs of stenosis or tumor recurrence, however, he continues multidisciplinary follow-up (Figure 3C).