� � � OBJECTIVES: �Combined defects of the skin, larynx, pharynx, and esophagus after central compartment exenteration can be extremely difficult to reconstruct.� The objective of this paper is to evaluate reconstruction of the central compartment using a combination of free jejunal transfer for pharyngoesophageal reconstruction, together with regional deltopectoral flaps for tracheostomal reconstruction and cutaneous resurfacing.� Myocutaneous flaps, such as pectoralis major and latissimus dorsi flaps, have been used previously for external coverage but can be bulky causing obstruction of the tracheostoma. � METHODS: �From 1995 to 2002, 7 patients underwent reconstruction of the central compartment with 7 jejunal and 9 deltopectoral flaps.� 5 patients required resection for tracheostomal recurrence of squamous cell carcinoma, while 2 patients required resection for massive pharyngocutaneous fistulae.� 6 patients had received previous radiotherapy.� Flap survival, complications and outcomes were evaluated retrospectively.� � RESULTS:� Mean age was 68.7 years.� Mean follow-up was 1.9 years.� Overall free jejunal and deltopectoral flap survival was 100% with no partial loss.� All patients maintained an adequate airway with stoma patency. Complications are summarized in Table 1.�� � CONCLUSIONS:� These complicated defects can be effectively repaired with free jejunal transfers to restore continuity of the alimentary tract, and deltopectoral flaps to reconstruct the tracheostoma and surrounding cutaneous defects.� The deltopectoral flap provides a large volume of well-vascularized tissue that provides reliable coverage of the newly reconstructed cervical esophagus and exposed major vessels following exenteration of the central compartment.� Its thin, pliable nature allows suturing of the tracheal remnants to skin edges without tension, and avoids intraluminal prolapse of excess soft tissues thus maintaining stomal patency.� � TABLE 1. �
COMPLICATIONS �	Total� No.�� ( n=7)
MAJOR	�
��� Peri-operative mortality	1
��� Pharyngocutaneous fistula	1
MINOR	�
��� Subclincal pharyngocutaneous leak	1
��� Cellulitis	1

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