Free Flap Inset Techniques in Salvage Laryngopharyngectomy Repair: Impact on Fistula Formation and Function
| Autor: | Vlad C. Sandulache, Nelson Eddie Liou, Peter Horwich, Andrew T. Huang, David J. Hernandez, Evan M. Graboyes, Diane W. Chen, Joshua D. Hornig, Terry A. Day, Erich M. Sturgis, Mark A. Ellis |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Cutaneous Fistula Fistula medicine.medical_treatment Laryngectomy Pharyngocutaneous Fistula Free flap Free Tissue Flaps 03 medical and health sciences Postoperative Complications 0302 clinical medicine Pharyngectomy medicine Humans 030223 otorhinolaryngology Laryngeal Neoplasms Aged Retrospective Studies business.industry Incidence (epidemiology) Pharyngeal Diseases Middle Aged Plastic Surgery Procedures medicine.disease Gastrostomy Surgery Tissue transfer Treatment Outcome Otorhinolaryngology 030220 oncology & carcinogenesis Carcinoma Squamous Cell Female business Single layer |
| Zdroj: | The Laryngoscope. 131 |
| ISSN: | 1531-4995 0023-852X |
| DOI: | 10.1002/lary.28939 |
| Popis: | To characterize pharyngocutaneous fistula (PCF) rates and functional outcomes following microvascular free tissue transfer (MVFTT) reconstruction of salvage total laryngectomy (STL) with a review of two different flap inset techniques and a review of the literature.Retrospective review.Review of the literature revealed 887 patients who underwent STL MVFTT from 14 references. Ninety-six STL MVFTTs were performed by the authors, with 36 (38%) patients undergoing multilayer fascial underlay (MLFU) closure and 60 (62%) a standard single layer closure (SLC). One (3%) PCF occurred in the MLFU group compared to 12 (20%) in the SLC cohort (P = .03). Postoperative gastrostomy (G)-tube dependence was lower following MLFU closure compared to SLC (25% vs. 57%, P .01), whereas pharyngoesophageal stricture (PES) (28% vs. 38%), tracheoesophageal puncture (TEP) placement (42% vs. 42%), and TEP usage (87% vs. 88%) did not significantly differ (P .05). Compared to pooled rates from the literature, patients who underwent a MLFU MVFTT inset technique demonstrated significantly lower PCF incidence (3% vs. 23%, P .01) without significant differences in PES (28% vs 23%, P = .55), G-tube dependence (25% vs. 23%, P = .25), or TEP placement (42% vs. 59%, P = .09).Despite MVFTT reconstruction after STL, G-tube dependence, PCF formation, and limitations of speaking rehabilitation (TEP) remain a significant issue. Modification of MVFTT inset may provide an opportunity to reduce PCF incidence without affecting other functional outcomes.4 Laryngoscope, 131:E875-E881, 2021. |
| Databáze: | OpenAIRE |
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