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This paper presents our surgical technique and the results of using bipedicled superior chest flaps for head and neck reconstructions. The study design consisted of a case series of surgical technique. The study was conducted at tertiary referral centers with otorhinolaryngology-head and neck surgery departments. In seven patients, we used bipedicled superior chest flaps for reconstruction of anterior cutaneous neck defects due to surgery for the recurrence of laryngopharyngeal carcinoma. The largest flap size was 45 × 14 cm. All donor sites were closed primarily with advancement in the lateral part and split thickness skin grafts in the superior midline of chest. The highest point of reconstruction was in the hypopharynx internally and hyoid externally. All flaps survived without major complications. A bipedicled upper chest flap can reliably cover the skin defects that create following salvage total laryngectomies in patients with advanced stage tumors with skin involvement. [ABSTRACT FROM AUTHOR]

A near-total laryngectomy or near-total laryngopharyngectomy with the creation of a speech shunt was carried out on 66 laryngopharyngeal cancer patients. Intelligible shunt speech was obtained in 50 patients (76%), while stenosis of the shunt occurred in 13 patients (20%), and asymptomatic aspiration in 4 (6%). Poor voice production was usually due to shunt stenosis, a fibrotic band surrounding the shunt, or local recurrence of tumor. Perioperative wound infection and postoperative irradiation did not interfere with the developement of shunt speech. In 12 patients with shunt stenosis, revision surgeries were performed to augment the shunt openings. During these procedures, the stenotic shunt was opened and a silastic tube was introduced into the shunt lumen to serve as a stent. For the moderately to severely stenotic shunt, the mucosal defect present was covered with a free skin graft or a sternocleidomastoid myoperiosteal flap. Following treatment, results demonstrated that 10 of the 12 patients acquired satisfactory shunt speech. In two unsuccessful cases, the causes of failure were wound infection and graft necrosis and were presumed to be complications of previous irradiation. [ABSTRACT FROM AUTHOR]