Reconstruction of a Pharyngeal Cutaneous Fistula Using a Bi-Paddled Pectoralis Major Flap for a Patient with a Possibility of Future Postoperative Radiotherapy
| Autor: | Tomoichiro Togo, Kenta Miyabe, Masaru Miyamoto, Hitoshi Nemoto, Daiki Morita, Sei Kobayashi |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
Leak medicine.medical_specialty medicine.medical_treatment Cutaneous Fistula Pharyngocutaneous Fistula Surgical Flaps Pectoralis Muscles Cervicoplasty medicine Humans Pectoralis Muscle business.industry Pectoralis major muscle Soft tissue General Medicine Articles Pharyngeal Diseases Middle Aged Plastic Surgery Procedures Surgery Pectoralis major flap Laryngectomy Radiation therapy Head and Neck Neoplasms Neoplasm Recurrence Local business |
| Zdroj: | The American Journal of Case Reports |
| ISSN: | 1941-5923 |
| Popis: | Patient: Male, 51-year-old Final Diagnosis: Pharyngeal cutaneous fistula Symptoms: Fistula • infection Medication: — Clinical Procedure: — Specialty: Oncology • Plastic Surgery • Surgery Objective: Unusual or unexpected effect of treatment Background: Pharyngocutaneous fistulas are often difficult to treat because pharyngeal contents tend to leak into the cervical layer causing wound infections or abscesses. If reconstruction with free flaps is difficult, pedicled pectoralis major flaps are an option. Case Report: A 51-year-old male patient who had undergone radiation and chemotherapy for laryngeal cancer was scheduled for total laryngectomy with combined skin resection for local tumor recurrence. Reconstruction with a left deltopectoral (DP) flap was performed. However, a pharyngocutaneous fistula constructed due to cervical soft-tissue infection required reconstruction using a right bi-paddled pectoralis major muscle. The anterior pharyngeal wall was reconstructed with the medial skin island, and the lateral skin island was folded back to reconstruct the soft tissues. Since this was the patient’s third recurrence, the possibility of subsequent local recurrences, and hence of the need for radiation therapy, were high. In such cases, the pedicle of the pectoralis major muscle flap is normally closed using a DP flap. However, in the present case, the DP flap had already been used on both sides. We therefore utilized a right bi-paddled pectoralis major flap for cervical reconstruction. Conclusions: We successfully reconstructed the cervical skin and soft tissue thickly, and primarily-closed the donor site, by creating a second skin island from surplus areas of the existing skin island. This method is particularly useful for the reconstruction of cervical skin and soft tissues due to the possible need for future radiation therapy, when the use of free flaps and DP flap is unfeasible. |
| Databáze: | OpenAIRE |
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