Abstract:ObjectiveTo summarize experience for repairing defects of tongue, pharynx, esophagus and cervical skin after resection of laryngeal and hypopharyngeal carcinoma.MethodsFrom Jan 2005 to Dec 2012, 177 patients suffering from laryngeal and hypopharyngeal carcinoma received surgical treatment in our department. Of them, 147 were male and 30 were female. Their age ranged from 42 to 75 years old with a median age of 51. Among the first time treatment cases, 49 were laryngeal carcinoma of stage IV and 44 were hypopharyngeal carcinoma of stage IV. Among the recurrence cases, 55 were laryngeal carcinoma and 29 were hypopharyngeal carcinoma. As for the resection of primary locus, total resection of larynx and hypopharynx was performed in 88 cases, total resection of larynx, hypopharynx and base tongue was performed in 29 cases, total resection of larynx, hypopharynx and cervical esophagus was performed in 22 cases, total resection of larynx, hypopharynx and pulledout the whole esophagus was performed in 11 cases, total resection of larynx, hypopharynx, cervical esophagus and skin was performed in 26 cases, total resection of tongue, larynx, hypopharynx and cervical esophagus and skin was performed in one. As for the postoperative defect and repair method, the nearcircumferential hypopharyngeal defects of 120 cases underwent reconstruction with single flap including submental flap in 25 cases, pectoralis major myocutaneous flap in 53, femoral anterolateral flap in 42. The circumferential hypopharyngeal and esophageal defects of 57 cases received reconstruction with single and/or composite flap(s): femoral anterolateral flap in 9 cases, pectoralis major myocutaneous flap plus thoracoacromal artery perforate flap in 6 and free jejunum flap in 21; multiple tissue flaps were utilized for reconstruction the defects of oralpharyngeal, circumferential hypopharyngeal, cervical esophageal and skin defects in 10 cases, including jejunum flap, pectoralis major myocutaneous flap or/and femoral anterolateral flap; 11 cases underwent gastricmigration and tubularstomach for reconstruction of gastricoropharyngeal anastomosis. 95 cases received postoperative radiotherapy without radiation necrosis.ResultsThe success rate of primary defect repair was 92.1%(163/177). The failed 14 cases, including 4 of jejunum flap, 6 of contralateral pectoralis major myocutaneous flap and 4 cases of free femoral anterolateral flap, were all successfully reconstructed via the second surgery. Pharyngeal fistula occurred in 6 cases and got healed after dressing change. Intraoperative death was absent. The 3year survival and 5year survival rates were 50.4% and 39.4% respectively.Conclusion①The pharyngeal,esophageal and skin defects after resection of advanced and recurrent laryngeal and hypopharyngeal carcinoma need to be repaired with suitable flaps according to the scope and size of defects and physical condition of the patients. ② Multiple flaps should be used in the complex defects of multiple tissues and organs to reconstruct upper gastrointestinal tract and skin. ③In order to ensure the successful reconstruction, the blood supply of flaps need to be closely observed, the failed flaps need to be given up and new flaps should be used as soon as possible.