Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-22T19:52:18.223Z Has data issue: false hasContentIssue false
  • English
  • Français

Tissue transfer to post-chemoradiation salvage laryngectomy defects to prevent pharyngocutaneous fistula: single-centre experience

Published online by Cambridge University Press:  01 April 2014

J Powell ,
U R Ullal ,
O Ahmed ,
M Ragbir  and
V Paleri
J Powell
Affiliation:
Department of Otolaryngology–Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne, UK
U R Ullal
Affiliation:
Department of Otolaryngology–Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne, UK
O Ahmed
Affiliation:
Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
M Ragbir
Affiliation:
Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
V Paleri*
Affiliation:
Department of Otolaryngology–Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne, UK
*
Address for correspondence: Mr V Paleri, Department of Otolaryngology – Head and Neck Surgery, Freeman Hospital, Newcastle Upon Tyne NE7 7DN, UK Fax: (44) 191 223 1246 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

In recent practice, we have used tissue transfer (pedicled or free flap) to augment the pharyngeal circumference of the neopharynx following salvage total laryngectomy, even in patients who have sufficient pharyngeal mucosa for primary closure. In this study, the rates of pharyngocutaneous fistula were compared in soft tissue flap reconstructed patients versus patients who underwent primary closure.

Method:

A retrospective assessment was carried out of all patients who had undergone a salvage total laryngectomy between 2000 and 2010. The presence or absence of a pharyngocutaneous fistula was compared in those who received reconstruction closure versus those who received primary closure.

Results:

The reconstruction closure group (n = 7) had no incidence of pharyngocutaneous fistula, whereas the primary closure group (n = 38) had 10 fistulas, giving pharyngocutaneous fistula rates of 0 per cent versus 26 per cent, respectively.

Conclusion:

The findings revealed a lower rate of pharyngocutaneous fistula with tissue transfer compared with primary closure of the neopharynx.

Keywords

LaryngectomyFistulaSalvage TherapyFree FlapPedicled FlapChemotherapyRadiotherapy
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 128 , Issue 4 , April 2014 , pp. 365 - 367
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

1Moyer, 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
2Forastiere, AA, Zhang, Q, Weber, RS, Maor, MH, Goepfert, H, Pajak, TF et al. Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol 2013;31:845–52CrossRefGoogle ScholarPubMed
3Weber, 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
4Ganly, 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
5Sewnaik, A, Keereweer, S, Al-Mamgani, A, Baatenburg de Jong, RJ, Wieringa, MH, Meeuwis, CA et al. High complication risk of salvage surgery after chemoradiation failures. Acta Otolaryngol 2012;132:96–100Google Scholar
6Makitie, AA, Irish, J, Gullane, PJ. Pharyngocutaneous fistula. Curr Opin Otolaryngol Head Neck Surg 2003;11:78–84CrossRefGoogle ScholarPubMed
7Cavalot, AL, Gervasio, CF, Nazionale, G, Albera, R, Bussi, M, Staffieri, A et al. Pharyngocutaneous fistula as a complication of total laryngectomy: review of the literature and analysis of case records. Otolaryngol Head Neck Surg 2000;123:587–92CrossRefGoogle ScholarPubMed
8Paydarfar, 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
9McLean, JN, Nicholas, C, Duggal, P, Chen, A, Grist, WG, Losken, A et al. Surgical management of pharyngocutaneous fistula after total laryngectomy. Ann Plast Surg 2012;68:442–5Google Scholar
10Withrow, 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
11Patel, UA, Keni, SP. Pectoralis myofascial flap during salvage laryngectomy prevents pharyngocutaneous fistula. Otolaryngol Head Neck Surg 2009;141:190–5CrossRefGoogle ScholarPubMed
12Oozeer, NB, Owen, S, Perez, BZ, Jones, G, Welch, AR, Paleri, V. Functional status after total laryngectomy: cross-sectional survey of 79 laryngectomees using the Performance Status Scale for Head and Neck Cancer. J Laryngol Otol 2010;124:412–16Google Scholar
13Fung, K, Teknos, TN, Vandenberg, CD, Lyden, TH, Bradford, CR, Hogikyan, ND et al. Prevention of wound complications following salvage laryngectomy using free vascularized tissue. Head Neck 2007;29:425–30Google Scholar
14Sinclair, CF, Rosenthal, EL, McColloch, NL, Magnuson, JS, Desmond, RA, Peters, GE et al. Primary versus delayed tracheoesophageal puncture for laryngopharyngectomy with free flap reconstruction. Laryngoscope 2011;121:1436–40CrossRefGoogle ScholarPubMed
15Paleri, V, Drinnan, M, van den Brekel, MW, Hinni, ML, Bradley, PJ, Wolf, GT et al. Vascularised tissue to reduce fistula following salvage total laryngectomy: a systematic review. Laryngoscope 2014. Epub 2014 Jan 29CrossRefGoogle ScholarPubMed