Despite the significant improvement in surgical and intensive care therapy, esophageal perforation is still a severe, life-threatening condition. As the underlying causes, the accompanying disorders, the localization and the extent of the inflammation vary, the surgeon may sometimes encounter unexpected situations. A 58-year-old female developed necrotizing mediastinitis due to esophageal perforation as the result of incarcerated thoracic hernia of the stomach, therefore, we had to perform esophagus extirpation and cervical esophagostomy. During the reconstruction of the intestinal tract, we found shrinkage of the complete esophageal stump with unknown cause. The gastric sleeve was joined to the hypopharynx. Insufficiency was solved with conservative therapy. The patient regained partial swallowing ability after complex dysphagia treatment. Hyophapharyngo-gastrostomy done due to non-malignant disease is extremely rare in the literature, however, it can be a surgical technique of choice if required as in our case. It should be followed by rehabilitation done by a team, with emphasis on dysphagia treatment. Orv Hetil. 2020; 161(18): 756-760.
A sebészi és az intenzív terápia jelentős fejlődése ellenére a nyelőcső-perforatio napjainkban is súlyos, életet veszélyeztető állapot. A háttérben álló kiváltó okok, a kísérő betegségek, a lokalizáció és a kialakuló gyulladás eltérő mértéke miatt néha váratlan szituációval találkozik a sebész. Az 58 éves nőbetegnél a gyomor mellűri inkarcerált herniája miatt kialakult oesophagusperforatio és a következményes nekrotizáló mediastinitis miatt végeztünk oesophagusexstirpatiót, cervicalis oesophagostomiát alakítottunk ki. A tápcsatorna rekonstrukciója során a nyelőcsőcsonk ismeretlen eredetű, teljes hosszát érintő „zsugorodását” találtuk. A csőgyomrot a hypopharynxra anasztomizáltuk, a kialakult insufficientia konzervatív terápiára szanálódott. A beteg komplex nyelésterápia után visszanyerte részleges nyelési képességét. A nem tumoros alapbetegség miatt képzett hypopharyngogastrostoma irodalmi ritkaság. Kényszerhelyzetben, mint amilyen az esetünk is volt, választható műtéti megoldás. A beavatkozást azonban teammunkán alapuló rehabilitációnak kell követnie, amelynek során kiemelt szerepe van a nyelési terápiának. Orv Hetil. 2020; 161(18): 756–760.

BACKGROUND: Hypopharyngeal reconstruction after salvage pharyngolaryngectomy results in high postoperative morbidity. The use of salivary bypass tubes can reduce pharyngocutaneous fistula (PCF) formation. The influence of bacterial colonization has not been described in literature.
METHODS: Bacterial swipes from 26 consecutive patients reconstructed after laryngopharyngectomy in combination with Montgomery salivary bypass tubes (MSBT) were analyzed in regards to PCF formation.
RESULTS: PCF occurred in 2 untreated primary and in 9 salvage laryngopharyngectomies, respectively. Bacterial colonization showed high rates of gram-negative pathogens and drug resistance to standard Ampicillin treatment. Type of bacteria was not associated with fistula formation. Antibiotic resistance was found in 6 out 11 patients (54%) with PCF.
CONCLUSIONS: We identified high rates of antibiotic-resistant Gram-negative pathogens on MSBT. Although not statistically significant, PCF were found more frequently in drug-resistant patients. Bacterial colonization of hypopharyngeal reconstructions should therefore be taken into account for perioperative prophylaxis.

Complete hypopharyngoesophageal (HPE) stenosis is rare and a challenging condition to treat. When endoscopic therapy fails, total laryngectomy with or without pharyngeal reconstruction is usually performed. We present a retrospective case series involving 3 patients with complete HPE stenosis who failed endoscopic repair and were gastrostomy dependent. All were managed successfully with the sternocleidomastoid myocutaneous (SCM) flap. A temporary fistula occurred in 1 patient. Hospitalization ranged from 5 to 15 days, patients resumed oral intake from 21 to 82 days postoperatively, and their gastrostomy tubes were removed from 28 to 165 days postoperatively. We suggest that the SCM flap is a laryngeal preservation option for reconstruction of complete HPE stenosis when endoscopic techniques fail. This flap allows HPE repair and reconstruction within the same surgical field, imposes no significant donor site morbidity, and affords good functional and cosmetic outcomes.

Surgeons have developed various reconstructive techniques to minimize the rate of pharyngocutaneous fistula and optimize functional outcome after salvage laryngectomy or laryngopharyngectomy.
Multicenter retrospective review at 33 institutions of 486 patients with a history of squamous cell carcinoma (SCC) of the larynx or hypopharynx previously treated with primary chemoradiotherapy (CRT) who required salvage surgery. Outcomes evaluated were overall fistula rate, fistula requiring reoperation, and 12-month speech and swallowing function.
Primary closure of the hypopharynx was associated with a statistically higher overall fistula rate and fistula requiring reoperation compared to reconstruction with vascularized tissue augmentation. Vascularized tissue augmentation with muscle led to worse 12-month \"understandability of speech\" and \"nutritional mode\" scores compared to vascularized tissue augmentation without muscle.
Vascularized tissue augmentation reduces the overall fistula rate and fistula requiring reoperation but vascularized tissue augmentation with muscle may impair speech and swallowing outcomes.

To explore the effectiveness of pedicled chimeric thoracoacromial artery perforator (TAAP) flap as a reconstructive option for circular hypopharyngeal defects.
Between January 2013 and December 2014, the pedicled chimeric TAAP flap was used to repair oncologic circular hypopharyngeal defects in 8 patients, included 6 males and 2 females, with an average age of 57 years (range, 45-80 years). All patients were treated in other hospitals before and recurrence was noted. The duration between latest treatment and recurrence ranged from 3 to 28 months (mean, 16.5 months). According to Union for International Cancer Control (UICC) TNM staged, 3 cases were T 2N 1M 0, 2 cases were T 3N 1M 0, 1 case was T 3N 2M 0, 2 cases were T 4N 1M 0. After laryngectomy, the size of circular hypopharyngeal defect ranged from 9.0 cm×8.5 cm to 12.0 cm×10.5 cm. The size of TAAP flap ranged from 7.0 cm×4.0 cm to 9.5 cm×6.0 cm．The size of pectoralis major flap ranged from 9.0 cm×5.0 cm to 14.5 cm×6.0 cm．The donor sites were closed directly in all cases.
Postoperatively all flaps survived smoothly, and all defects healed by first intention. No early complication was noted. The mean hospital stay period ranged from 12 to 22 days (mean, 14.5 days). All patients were followed up 12-45 months (mean, 18.7 months). Patients possessed good appearance of surgical sites. No recurrence, fistulas, stenosis/strictures, dehiscence, or swelling occurred. Only linear scars were left on the donor sites, and the pectoralis major muscle function was completely preserved in all patients.
Patients with high comorbidities may not be suitable candidates for free flap reconstruction, especially when the recipient vessels are affected from disease or radiotherapy. Pedicled chimeric TAAP flap is a good choice for the reconstruction of hypopharyngeal defects in such conditions．.
探讨带蒂胸肩峰动脉嵌合穿支肌皮瓣修复下咽环周缺损的临床效果。.
2013 年 1 月—2014 年 12 月，采用带蒂胸肩峰动脉嵌合穿支肌皮瓣修复 8 例复杂性下咽环周缺损患者。男 6 例，女 2 例；年龄 45～80 岁，平均 57 岁。均为外院治疗后下咽癌复发者，结束治疗至复发确诊时间为 3～28 个月，平均 16.5 个月。按国际抗癌联盟（UICC）TNM 分类分期：T 2N 1M 0 3 例，T 3N 1M 0 2 例，T 3N 2M 0 1 例，T 4N 1M 0 2 例。全喉全下咽切除术后，下咽环周缺损范围为 9.0 cm×8.5 cm～12.0 cm×10.5 cm；带蒂胸肩峰动脉嵌合穿支肌皮瓣的穿支皮瓣皮岛范围为 7.0 cm×4.0 cm～9.5 cm×6.0 cm，胸大肌肌皮瓣皮岛范围为 9.0 cm×5.0 cm～14.5 cm×6.0 cm。供区均直接拉拢缝合。.
术后皮瓣顺利成活，创面Ⅰ期愈合。供区切口均Ⅰ期愈合，无早期相关并发症发生。患者住院时间 12～22 d，平均 14.5 d。术后 8 周患者均恢复正常饮食。患者均获随访，随访时间 12～45 个月，平均 18.7 个月。所有患者颈部外形良好，未见肿瘤复发，未发生咽瘘、切口裂开和肿胀等情况，皮瓣不臃肿，重建的下咽腔无狭窄。供区仅遗留线性瘢痕，胸大肌功能未见明显影响。.
复杂的下咽环周缺损往往存在颈部受区血管缺如情况，不适合采用游离组织瓣移植修复，带蒂胸肩峰动脉嵌合穿支肌皮瓣可以作为一种局部重建替代治疗方案。.

The reconstruction of hypopharyngeal defects should focus on minimizing morbidity in a high-risk population while achieving adequate functional results with regard to the restoration of speech, swallowing, and airway control. We introduce the clinical application of the thoracoacromial artery perforator (TAAP) flap as a new reconstructive option for hypopharyngeal defects.
This method was used to restore oncologic hypopharyngeal defects in nine patients: three who had previous irradiation and surgery, one who had previous surgery only, and another who had previous radiotherapy only.
All of the TAAP flaps of our series were transferred successfully and survived entirely. The donor sites were closed primarily in all cases. No fistulas, stenosis/strictures, dehiscence, or swelling occurred. Pectoralis major muscle function was completely preserved in all patients.
The use of TAAP flap to reconstruct hypopharyngeal defect is a simple and effective method that does not require microsurgical skills. The flap is thin and pliable, with a reliable blood supply.
4. Laryngoscope, 126:1315-1320, 2016.

This article reviews the literature on esophageal reconstruction. The most common methods used are gastric pull-up, pectoralis major flap, colon interposition, fasciocutaneous flaps (radial forearm free flap or anterolateral thigh flap), and free jejunum and colon flaps. The stricture rates, fistula rates, morbidity, and mortality of each flap are reviewed.