Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-23T16:00:24.988Z Has data issue: false hasContentIssue false
  • English
  • Français

Pectoralis major myofascial flap in salvage laryngectomy

Published online by Cambridge University Press:  15 July 2014

E Cömert ,
Ü Tunçel ,
M Taner Torun ,
C Kiliç ,
A Buğra Cengiz ,
Z şencan  and
M Kaya
E Cömert*
Affiliation:
Department of Otolaryngology, Ankara Oncology Education and Research Hospital, Turkey
Ü Tunçel
Affiliation:
Department of Otolaryngology, Ankara Oncology Education and Research Hospital, Turkey
M Taner Torun
Affiliation:
Department of Otolaryngology, Faculty of Medicine, Erzincan University, Turkey
C Kiliç
Affiliation:
Department of Otolaryngology, Faculty of Medicine, Ordu University, Turkey
A Buğra Cengiz
Affiliation:
Department of Otolaryngology, Ankara Oncology Education and Research Hospital, Turkey
Z şencan
Affiliation:
Department of Otolaryngology, Ankara Oncology Education and Research Hospital, Turkey
M Kaya
Affiliation:
Department of Otolaryngology, Ankara Oncology Education and Research Hospital, Turkey
*
Address for correspondence: Dr Ela CömertAnkara Oncology Education and Research Hospital, Mehmet Akif Ersoy mah., 06200, Yenimahalle, AnkaraTurkey Fax: +90 312 345 49 79 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

The main purpose of this study was to evaluate the effect of the pectoralis major myofascial flap on pharyngocutaneous fistula formation and time to oral feeding.

Methods:

This retrospective study reviewed 155 total laryngectomies. Patients were divided into two main groups. Group 1 included 110 patients who were treated primarily by total laryngectomy and group 2 comprised 45 patients who were treated by salvage laryngectomy with or without a pectoralis major myofascial flap.

Results:

The use of a pectoralis major myofascial flap did not have a significant effect on pharyngocutaneous fistula formation in the salvage group (p = 0.376). When comparing the oral feeding day of patients with pharyngocutaneous fistula, a significant difference was observed between the salvage group with pectoralis major myofascial flap reinforcement and the salvage group without pectoralis major myofascial flap reinforcement (p = 0.004).

Discussion:

Our study demonstrated that pectoralis major myofascial flap reinforcement did not decrease the rate of pharyngocutaneous fistula formation. Instead, it prevented the formation of large fistulas that would require surgical management, and showed a similar time to oral feeding and length of hospital stay to primary laryngectomy.

Keywords

Salvage TherapyLaryngectomyFistulaPectoralis Muscles
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 128 , Issue 8 , August 2014 , pp. 714 - 719
Copyright
Copyright © JLO (1984) Limited 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Rosai, J. Ackerman's Surgical Pathology, 8th edn.St Louis: Mosby, 1996;319–23Google Scholar
2Gillison, ML, Forastiere, AA. Larynx preservation in head and neck cancers. A discussion of the National Comprehensive Cancer Network Practice Guidelines. Hematol Oncol Clin North Am 1999;13:699–718CrossRefGoogle ScholarPubMed
3Hoffman, HT, McCulloch, T, Gustin, D, Karnell, LH. Organ preservation therapy for advanced-stage laryngeal carcinoma. Otolaryngol Clin North Am 1997;30:113–30CrossRefGoogle ScholarPubMed
4Moyer, JS, Wolf, GT, Bradford, CR. Current thoughts on the role of chemotherapy and radiation in advanced head and neck cancer. Curr Opin Otolaryngol Head Neck Surg 2004;12:82–7CrossRefGoogle ScholarPubMed
5Withrow, KP, Rosenthal, EL, Gourin, CG, Peters, GE, Magnuson, JS, Terris, DJ et al. Free tissue transfer to manage salvage laryngectomy defects after organ preservation failure. Laryngoscope 2007;117:781–4Google Scholar
6Davidson, BJ, Newkirk, KA, Harter, KW, Picken, CA, Cullen, KJ, Sessions, RB. Complications from planned, posttreatment neck dissections. Arch Otolaryngol Head Neck Surg 1999;125:401–5Google Scholar
7Sassler, AM, Esclamado, RM, Wolf, GT. Surgery after organ preservation therapy. Analysis of wound complications. Arch Otolaryngol Head Neck Surg 1995;121:162–5Google Scholar
8Gil, Z, Gupta, A, Kummer, B, Cordeiro, PG, Kraus, DH, Shah, JP et al. The role of pectoralis major muscle flap in salvage total laryngectomy. Arch Otolaryngol Head Neck Surg 2009;135:1019–23CrossRefGoogle ScholarPubMed
9Applebaum, EL, Levine, HL. Pharyngeal reconstruction after laryngectomy. Laryngoscope 1977;87:1884–90CrossRefGoogle ScholarPubMed
10Berry, SM, Fischer, JE. Classification and pathophysiology of enterocutaneous fistulas. Surg Clin North Am 1996;76:1009–18Google Scholar
11Celikkanat, S, Koç, C, Akyol, MU, Ozdem, C. Effect of blood transfusion on tumor recurrence and postoperative pharyngocutaneous fistula formation in patients subjected to total laryngectomy. Acta Otolaryngol 1995;115:566–8CrossRefGoogle ScholarPubMed
12Sousa, AA, Castro, SM, Porcaro-Salles, JM, Soares, JM, de Moraes, GM, Carvalho, JR et al. The usefulness of a pectoralis major myocutaneous flap in preventing salivary fistulae after salvage total laryngectomy. Braz J Otorhinolaryngol 2012;78:103–7Google Scholar
13Tsou, YA, Hua, CH, Lin, MH, Tseng, HC, Tsai, MH, Shaha, A. Comparison of pharyngocutaneous fistula between patients followed by primary laryngopharyngectomy and salvage laryngopharyngectomy for advanced hypopharyngeal cancer. Head Neck 2010;32:1494–500CrossRefGoogle ScholarPubMed
14Ariyan, S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg 1979;63:73–81CrossRefGoogle ScholarPubMed
15Paydarfar, JA, Birkmeyer, NJ. Complications in head and neck surgery: A meta-analysis of postlaryngectomy pharyngocutaneous fistula. Arch Otolaryngol Head Neck Surg 2006;132:67–72Google Scholar
16Gooi, Z, Richmon, J. Long-term oral intake through a salivary bypass tube with chronic pharyngocutaneous fistula. Am J Otolaryngol 2012;33:762–3Google Scholar
17Ganly, I, Patel, S, Matsuo, J, Singh, B, Kraus, D, Boyle, J et al. Postoperative complications of salvage total laryngectomy. Cancer 2005;103:2073–81CrossRefGoogle ScholarPubMed
18Weber, RS, Berkey, BA, Forastiere, A, Cooper, J, Maor, M, Goepfert, H et al. Outcome of salvage total laryngectomy following organ preservation therapy: The Radiation Therapy Oncology Group trial 91-11. Arch Otolaryngol Head Neck Surg 2003;129:44–9CrossRefGoogle ScholarPubMed
19White, HN, Golden, B, Sweeny, L, Carroll, WR, Magnuson, JS, Rosenthal, EL. Assessment and incidence of salivary leak following laryngectomy. Laryngoscope 2012;122:1796–9Google Scholar
20Patel, UA, Keni, SP. Pectoralis myofascial flap during salvage laryngectomy prevents pharyngocutaneous fistula. Otolaryngol Head Neck Surg 2009;141:190–5Google Scholar
21Hanasono, MM, Lin, D, Wax, MK, Rosenthal, EL. Closure of laryngectomy defects in the age of chemoradiation therapy. Head Neck 2012;34:580–8Google Scholar
22Furuta, Y, Homma, A, Oridate, N, Suzuki, F, Hatakeyama, H, Suzuki, K et al. Surgical complications of salvage total laryngectomy following concurrent chemoradiotherapy. Int J Clin Oncol 2008;13:521–7Google Scholar
23Milenović, A, Virag, M, Uglesić, V, Aljinović-Ratković, N. The pectoralis major flap in head and neck reconstruction: First 500 patients. J Craniomaxillofac Surg 2006;34:340–3CrossRefGoogle ScholarPubMed
24Righini, C, Lequeux, T, Cuisnier, O, Morel, N, Reyt, E. The pectoralis myofascial flap in pharyngolaryngeal surgery after radiotherapy. Eur Arch Otorhinolaryngol 2005;262:357–61Google Scholar
25Smith, TJ, Burrage, KJ, Ganguly, P, Kirby, S, Drover, C. Prevention of postlaryngectomy pharyngocutaneous fistula: The Memorial University experience. J Otolaryngol 2003;32:222–5Google Scholar