PMC7575643_01
Tumorresection with laryngectomy, partial pharyngectomy, and bilateral modified radical neck dissection.. (a) Tumor mass of the right pharynx. The tumor infiltrates the thyroid gland, the piriform sinus, the larynx, the hyoid bone, the tonsil on the right side and the dorsal pharyngeal wall; (b) resection defect. T = Tongue; TC = Thyroid cartilage; S = Submandibular gland; M = Sternocleidomastoid muscle.
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The definitive tumor therapy follows with a laryngectomy, partial pharyngectomy, and bilateral modified radical neck dissection (Fig. 1).
Critical situation of pedicled flaps.. (a) Flap necrosis in the cranial part of the right sided deltopectoral flap after applying a pharyngostoma on the right side; (b) Defect closure of the suprastomal fistula with a deltopectoral flap from the left side. Tissue necrosis of the right and cranial graft portion.
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On the fifth postoperative day, the superior part of the deltopectoral flap was lividly discolored (Fig. 2a). On the 10th postoperative day, a livid discoloration of the right peripheral flap margin occurred but did not continue proximally towards the flap's base (Fig. 2b).
Final result after completed wound healing (one year after surgery).
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The cosmetic result was quite acceptable so that the patient has regained a high level of quality of life as shown in Fig. 3 one year after surgery.
CT scan of the neck and thorax.. (a) Stenosis of the right subclavian artery (red arrow); (b) Outlet of the internal mammary artery on the right (red arrow); (c) Stenosis of the left subclavian artery (red arrow).
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However, we could identify the stenosis of the subclavian artery in the proximity of its outlets on both sides of the neck, responsible for flap failure (Fig. 4).