Optimizing Outcomes in Pharyngoesophageal Reconstruction and Neck Resurfacing: 10-Year Experience of 294 Cases
| Autor: | Matthew M. Hanasono, Olivier Boa, Roman J. Skoracki, Peirong Yu, Amy Xue, Mario G. Solari, Basel Sharaf, Jesse C. Selber, Jun Liu |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Dermatologic Surgical Procedures Free flap Pharyngocutaneous Fistula 030230 surgery Free Tissue Flaps 03 medical and health sciences 0302 clinical medicine Esophagus Postoperative Complications Swallowing medicine Humans Speech Prospective Studies Prospective cohort study business.industry Local flap Middle Aged Plastic Surgery Procedures Surgery Deglutition Radiation therapy medicine.anatomical_structure Treatment Outcome 030220 oncology & carcinogenesis Pharynx Female business Algorithms Neck |
| Zdroj: | Plastic and reconstructive surgery. 139(1) |
| ISSN: | 1529-4242 |
| Popis: | BACKGROUND Pharyngoesophageal reconstruction is a complex endeavor that poses many challenges. This 10-year series examines factors impacting the need for neck skin resurfacing and evaluates the impact of reconstructive modalities on outcomes. METHODS A review identified 294 patients who underwent pharyngoesophageal reconstruction from 2002 to 2012. Patients were divided based on neck skin resurfacing requirements. Patients undergoing neck resurfacing were further subdivided into reconstructive technique, including a second skin paddle or muscle component from the same free flap pedicle, a local flap, or a second free flap. All groups were compared by comorbidities, complications, and functional outcomes. RESULTS Of 294 patients, 179 (60.9 percent) required neck skin resurfacing. In the resurfaced group, there were 90 circumferential defects (50.3 percent) and 89 partial defects (49.7 percent). In the resurfaced group, 110 (61.4 percent) underwent reconstruction with a second skin paddle from the same free flap pedicle, 21 (11.7 percent) underwent reconstruction with a muscle component from the same pedicle, and 25 (13.9 percent) received a pectoralis major flap. There were five external paddle flap losses in the resurfaced group (2.8 percent) and no internal flap losses. Overall complications were similar among groups. The resurfaced group had a lower pharyngocutaneous fistula rate (4.5 percent) compared with the primary closure group (11.3 percent) (p = 0.026). Prior neck surgery and radiation therapy were strong predictors of neck skin resurfacing (p < 0.001). CONCLUSIONS Neck resurfacing is often required in salvage pharyngoesophageal reconstruction. Providing additional vascularized tissue over the neoconduit is predictive of lower pharyngocutaneous fistula rates. An algorithmic approach to neck resurfacing is presented. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|