Oral intake recovery following salvage laryngectomy with circumferential free flap reconstruction in a patient with prior pharyngogastric anastomosis and chemoradiation

Salvage laryngopharyngectomy in patients with a prior history of chemoradiation and surgery constitutes a substantial reconstructive challenge. Functional recovery is often limited by compromised vascular integrity combined with loss of pharyngeal mucosa, contributing to high rates of post-operative complications. We present a patient with squamous cell carcinoma of the esophagus, previously managed with chemoradiation and salvage esophagectomy with pharyngogastric anastomosis. She developed a second recurrence involving the pyriform sinus adjacent to the neoesophagus, requiring salvage laryngopharyngectomy and circumferential free flap reconstruction. An anterolateral thigh microvascular free flap was anastomosed to the gastric conduit. Despite significant risk factors of anatomic defect and hypovascularity, the patient successfully regained oral intake. This case demonstrates that favorable functional outcomes are possible in medically complex patients undergoing salvage reconstruction.