(a) Total laryngectomy and circumferential pharyngectomy defect in a patient unfit for free flap reconstruction. Posterior pharyngeal wall previously reconstructed with DP flap. (b) DP flap divided. Edges of neopharyngeal wall mobilized. Pectoralis major (PM) flap raised for anterior pharyngeal wall reconstruction. (c) Neopharynx reconstructed with divided DP flap as posterior wall and PM flap as anterior wall. (d) Undersurface of PM flap covered with skin graft. Base of previous DP flap used to protect anastomosis and prevent salivary spillage into the tracheostomy in case of leakage. Axillary flap was also raised to cover the chest wall defect in this patient.
