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