Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-29T08:58:11.086Z Has data issue: false hasContentIssue false
  • English
  • Français

Prevention of pharyngocutaneous fistula in salvage total laryngectomy: role of the pectoralis major flap and peri-operative management

Published online by Cambridge University Press:  07 March 2018

P Sittitrai ,
C Srivanitchapoom  and
D Reunmakkaew
P Sittitrai*
Affiliation:
Department of Otolaryngology, Chiang Mai University Hospital, Thailand
C Srivanitchapoom
Affiliation:
Otolaryngology Unit, Phayao Hospital, Thailand
D Reunmakkaew
Affiliation:
Department of Otolaryngology, Chiang Mai University Hospital, Thailand
*
Address for correspondence: Dr Pichit Sittitrai, Department of Otolaryngology, Chiang Mai University Hospital, Chiang Mai, Thailand, 50200 Fax: +66 053 935564 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

This study aimed to evaluate the impact of an onlay pectoralis major flap in reducing the incidence of pharyngocutaneous fistula after salvage total laryngectomy and determine the complications of pectoralis major flap reconstruction.

Methods:

A retrospective study was conducted of consecutive patients who underwent salvage total laryngectomy between 1995 and 2016. The pharyngeal defects were primarily closed with or without the pectoralis major flap.

Results:

Of 64 patients, 34 had primary pharyngeal closure alone (control group) and 30 received an onlay pectoralis major flap (pectoralis major flap group). The overall fistula rate was 15.6 per cent, with 17.6 per cent occurring in the control group and 13.3 per cent in the pectoralis major flap group (p = 0.74). The incidence rates of voice failure (p = 0.02) and shoulder disability (p < 0.001) were significantly higher in the pectoralis major flap group.

Conclusion:

The pectoralis major flap in salvage total laryngectomy did not decrease the pharyngocutaneous fistula rate, and the incidence of flap-related complications was high. Appropriate surgical technique and post-operative care may reduce the incidence of pharyngocutaneous fistula.

Keywords

LarynxHypopharynxFistulaLaryngectomyPectoralis MuscleMyocutaneous Flap
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 3 , March 2018 , pp. 246 - 251
Copyright
Copyright © JLO (1984) Limited 2018 

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

1 Sayles, M, Grant, DG. Preventing pharyngo-cutaneous fistula in total laryngectomy: a systematic review and meta-analysis. Laryngoscope 2014;124:1150–63Google Scholar
2 Gendreau-Lefèvre, AK, Audet, N, Maltais, S, Thuot, F. Prophylactic pectoralis major muscle flap in prevention of pharyngocutaneous fistula in total laryngectomy after radiotherapy. Head Neck 2015;37:1233–8Google Scholar
3 Patel, UA, Moore, BA, Wax, M, Rosenthal, E, Sweeny, L, Militsakh, ON et al. Impact of pharyngeal closure technique on fistula after salvage laryngectomy. JAMA Otolaryngol Head Neck Surg 2013;139:1156–62CrossRefGoogle ScholarPubMed
4 Sharma, S, Chaukar, DA, Laskar, SG, Kapre, N, Deshmukh, A, Pai, P et al. Role of the pectoralis major myofascial flap in preventing pharyngocutaneous fistula following salvage laryngectomy. J Laryngol Otol 2016;130:860–4Google Scholar
5 Gil, 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;135:1019–23Google Scholar
6 Guimarães, AV, Aires, FT, Dedivitis, RA, Kulcsar, MA, Ramos, DM, Cernea, CR et al. Efficacy of pectoralis major muscle flap for pharyngocutaneous fistula prevention in salvage total laryngectomy: a systematic review. Head Neck 2016;38(suppl 1):E2317–21Google Scholar
7 Hasan, Z, Dwivedi, RC, Gunaratne, DA, Virk, SA, Palme, CE, Riffat, F. Systematic review and meta-analysis of the complications of salvage total laryngectomy. Eur J Surg Oncol 2017;43:42–51 Google Scholar
8 Dedivitis, RA, Aires, FT, Cernea, CR, Brandão, LG. Pharyngocutaneous fistula after total laryngectomy: systematic review of risk factors. Head Neck 2015;37:1691–7CrossRefGoogle ScholarPubMed
9 Liang, JW, Li, ZD, Li, SC, Fang, FQ, Zhao, YJ, Li, YG. Pharyngocutaneous fistula after total laryngectomy: a systematic review and meta-analysis of risk factors. Auris Nasus Larynx 2015;42:353–9Google Scholar
10 Paleri, V, Drinnan, M, van den Brekel, MW, Hinni, ML, Bradley, PJ, Wolf, GT et al. Vascularized tissue to reduce fistula following salvage total laryngectomy: a systematic review. Laryngoscope 2014;124:1848–53Google Scholar
11 Righini, 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
12 Cömert, E, Tunçel, Ü, Torun, MT, Kiliç, C, Cengiz, AB, Sencan, Z et al. Pectoralis major myofascial flap in salvage laryngectomy. J Laryngol Otol 2014;128:714–19Google Scholar
13 Patel, UA, Keni, SP. Pectoralis myofascial flap during salvage laryngectomy prevents pharyngocutaneous fistula. Otolaryngol Head Neck Surg 2009;141:190–5Google Scholar
14 Oosthuizen, JC, Leonard, DS, Kinsella, JB. The role of pectoralis major myofascial flap in salvage laryngectomy: a single surgeon experience. Acta Otolaryngol 2012;132:1002–5Google Scholar
15 Sakai, A, Okami, K, Sugimoto, R, Ebisumoto, K, Yamamoto, H, Maki, D et al. Prevention of wound complications in salvage pharyngolaryngectomy by the use of well-vascularized flaps. Acta Otolaryngol 2012;132:778–82CrossRefGoogle ScholarPubMed
16 Sousa, 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
17 Sayles, M, Koonce, SL, Harrison, L, Beasley, N, McRae, AR, Grant, DG. Pharyngo-cutaneous fistula complicating laryngectomy in the chemoradiotherapy organ-preservation epoch. Eur Arch Otorhinolaryngol 2014;271:1765–9Google Scholar
18 Gilbert, MR, Sturm, JJ, Gooding, WE, Johnson, JT, Kim, S. Pectoralis major myofascial onlay and myocutaneous flaps and pharyngocutaneous fistula in salvage laryngectomy. Laryngoscope 2014;124:2680–6Google Scholar
19 Rothmeier, N, Bergmann, C, Mattheis, S, Weller, P, Lang, S. The primary use of pectoralis myofascial flap in salvage laryngectomy [in German]. Laryngorhinootologie 2015;94:232–8Google ScholarPubMed
20 Rappaport, WD, Hunter, GC, Allen, R, Lick, S, Halldorsson, A, Chvapil, T et al. Effect of electrocautery on wound healing in midline laparotomy incisions. Am J Surg 1990;160:618–20Google Scholar
21 Kumagai, SG, Rosales, RF, Hunter, GC, Rappaport, WD, Witzke, DB, Chvapil, TA et al. Effects of electrocautery on midline laparotomy wound infection. Am J Surg 1991;162:620–2;discussion 622–3CrossRefGoogle ScholarPubMed
22 Ruidiaz, ME, Messmer, D, Atmodjo, DY, Vose, JG, Huang, EJ, Kummel, AC et al. Comparative healing of human cutaneous surgical incisions created by the PEAK PlasmaBlade, conventional electrosurgery, and a standard scalpel. Plast Reconstr Surg 2011;128:104–11CrossRefGoogle Scholar
23 Moukarbel, RV, Doyle, PC, Yoo, JH, Franklin, JH, Day, AM, Fung, K. Voice-related quality of life (V-RQOL) outcomes in laryngectomees. Head Neck 2011;33:31–6CrossRefGoogle ScholarPubMed