[Free forearm skin flap with vascular microanastomosis in the reconstruction of the posterior pharyngeal wall].

The posterior wall of the oropharynx and hypopharynx is a single anatomo-functional structure which is artificially divided into oro and hypo by an imaginary line at the valleculae floor level. From the oncological point of view this division serves merely for classification purposes. In fact, the tumors of the posterior wall of both the oro and hypopharynx have the same risk factors, the same lymphatic drain, the same clinical behaviour, the same means of treatment and, almost certainly, the same prognosis. One of the most important problems after posterior pharyngeal wall resection and larynx preservation, is reconstruction without interfering with laryngeal functions. Between April 1990 and April 1991 four patients with squamous cell carcinoma of the posterior pharyngeal wall underwent, surgery after a complete staging including CT and panendoscopy. All underwent bilateral neck dissection, resection of the tumor preserving the larynx and free forearm flap reconstruction. The anastomosis between the radial and superior thyroid arteries and between the venae comitantes and the branches of the internal or external jugular veins were performed under operating microscope with the microvascular technique. The overall average surgical time was 8 hours. No flap necrosis, fistulae or donor site morbidity were observed. Postoperative radiotherapy was initiated without delay. This approach was chosen because, in the authors' experience, in cases of advanced posterior pharyngeal wall cancer, the results of radiotherapy alone are quite disappointing. The feasibility of surgical resection with good, radical macroscopic margins, easily allows margins which are microscopically free of disease and this is an important prognostic factor.(ABSTRACT TRUNCATED AT 250 WORDS)