Oropharyngeal, Tongue, and Esophageal Reconstruction — ALT, Radial Forearm, Jejunum, and Pharyngoesophageal Strategy

This episode reviews the core principles of oropharyngeal, tongue, and pharyngoesophageal reconstruction, focusing on defect analysis, flap selection, and functional restoration.Topics include the reconstructive goals of alimentary continuity, carotid protection, speech, swallowing, and aspiration prevention. The episode emphasizes the “snowball effect” of salivary leak, where small fistulas can lead to infection, vessel exposure, and catastrophic carotid blowout.Flap strategies are reviewed for major head and neck defects, including the anterolateral thigh flap, radial forearm free flap, jejunum free flap, and pectoralis major flap. Key decision points include thin pliable reconstruction for hemiglossectomy, bulk restoration for total glossectomy, and the need for the reconstructed tongue to contact the palate for swallowing.Pharyngoesophageal reconstruction is discussed through partial versus circumferential defects, including the 9.4 cm rule for tubed reconstruction, prevention of T-junction leaks, jejunal flap trade-offs, gastric pull-up indications, sentinel skin paddle monitoring, vessel-depleted neck strategies, fistula prevention, stricture management, TEP speech rehabilitation, and chimeric ALT flap design.Part of Dr. Lara’s Plastic Surgery Compendium — a high-yield audio reference for plastic surgery trainees and surgeons.DisclaimerThis podcast is intended for educational purposes only and is designed for medical students, residents, fellows, and practicing healthcare professionals. It is not intended to provide medical advice, diagnosis, or treatment for any individual patient. The content presented reflects general surgical principles and should not be used as a substitute for formal medical training, clinical judgment, or consultation with qualified healthcare professionals. Listening to this podcast does not establish a physician–patient relationship.SEO / Topic Keywordsoropharyngeal reconstruction, tongue reconstruction, pharyngoesophageal reconstruction, ALT flap head and neck, radial forearm free flap tongue, hemiglossectomy reconstruction, total glossectomy reconstruction, jejunum free flap, pectoralis major flap, salivary fistula, carotid blowout, sentinel skin paddle, vessel depleted neck, transverse cervical vessels, tubed ALT flap, 9.4 cm rule, TEP speech rehabilitation, chimeric ALT flap