Hostname: page-component-745bb68f8f-l4dxg Total loading time: 0 Render date: 2025-01-11T11:53:36.084Z Has data issue: false hasContentIssue false
  • English
  • Français

Role of the pectoralis major myofascial flap in preventing pharyngocutaneous fistula following salvage laryngectomy

Published online by Cambridge University Press:  08 August 2016

S Sharma ,
D A Chaukar ,
S G Laskar ,
N Kapre ,
A Deshmukh ,
P Pai ,
P Chaturvedi  and
A D'Cruz
S Sharma
Affiliation:
Department of Head Neck Services, Tata Memorial Hospital, Mumbai, India
D A Chaukar*
Affiliation:
Department of Head Neck Services, Tata Memorial Hospital, Mumbai, India
S G Laskar
Affiliation:
Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
N Kapre
Affiliation:
Department of Head Neck Services, Tata Memorial Hospital, Mumbai, India
A Deshmukh
Affiliation:
Department of Head Neck Services, Tata Memorial Hospital, Mumbai, India
P Pai
Affiliation:
Department of Head Neck Services, Tata Memorial Hospital, Mumbai, India
P Chaturvedi
Affiliation:
Department of Head Neck Services, Tata Memorial Hospital, Mumbai, India
A D'Cruz
Affiliation:
Department of Head Neck Services, Tata Memorial Hospital, Mumbai, India
*
Address for correspondence: Dr D Chaukar, 1226 Homi Bhabha Block, Dr E Borges Marg, Tata Memorial Hospital, Parel, Mumbai 400012, India Fax: +91 24146937 E-mail: dchaukar@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

This study aimed to assess the utility of onlay pectoralis major myofascial flap in preventing pharyngocutaneous fistula following salvage total laryngectomy.

Methods:

A retrospective analysis was performed of 172 patients who underwent salvage laryngectomy for recurrent carcinoma of the larynx or hypopharynx between 1999 and 2014. One hundred and ten patients underwent primary closure and 62 patients had pectoralis major myofascial flap onlay.

Results:

The overall pharyngocutaneous fistula rate was 43 per cent, and was similar in both groups (primary closure group, 43.6 per cent; onlay flap group, 41.9 per cent; p = 0.8). Fistulae in the onlay flap group healed faster: the median and mean fistula duration were 37 and 55 days, respectively, in the primary closure group and 20 and 25 days, respectively, in the onlay flap group (p = 0.008).

Conclusion:

Use of an onlay pectoralis major myofascial flap did not decrease the pharyngocutaneous fistula rate, although fistula duration was shortened. A well-designed randomised-controlled trial is needed to establish parameters for its routine use in clinical practice.

Keywords

FistulaLaryngectomySurgical Flaps
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 130 , Issue 9 , September 2016 , pp. 860 - 864
Copyright
Copyright © JLO (1984) Limited 2016 

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.)

Footnotes

Presented as an oral paper at the joint Fifth World Congress of the International Federation of Head and Neck Oncologic Society and 2014 Annual Meeting of the American Head and Neck Society, 29 July 2014, New York, USA

References

1 The Department of Veterans Affairs Laryngeal Cancer Study Group. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med 1991;324:1685–90Google Scholar
2 Forastiere, AA, Goepfert, H, Maor, M, Pajak, TF, Weber, R, Morrison, W et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003;349:2091–8Google Scholar
3 Sassler, AM, Esclamado, RM, Wolf, GT. Surgery after organ preservation therapy. Analysis of wound complications. Arch Otolaryngol Head Neck Surg 1995;121:162–5Google Scholar
4 Johansen, LV, Overgaard, J, Elbrønd, O. Pharyngocutaneous fistulae after laryngectomy. Influence of previous radiotherapy and prophylactic metronidazole. Cancer 1988;61:673–8Google Scholar
5 Papazoglou, G, Doundoulakis, G, Terzakis, G, Dokianakis, G. Pharyngocutaneous fistula after total laryngectomy: incidence, cause, and treatment. Ann Otol Rhinol Laryngol 1994;103:801–5Google Scholar
6 Grau, C, Johansen, LV, Hansen, HS, Andersen, E, Godballe, C, Andersen, LJ et al. Salvage laryngectomy and pharyngocutaneous fistulae after primary radiotherapy for head and neck cancer: a national survey from DAHANCA. Head Neck 2003;25:711–16Google Scholar
7 Sarkar, S, Mehta, SA, Tiwari, J, Mehta, AR, Mehta, MS. Complications following surgery for cancer of the larynx and pyriform fossa. J Surg Oncol 1990;43:245–9Google Scholar
8 Aprigliano, F. Use of the nasogastric tube after total laryngectomy: is it truly necessary? Ann Otol Rhinol Laryngol 1990;99:513–14Google Scholar
9 Seikaly, H, Park, P. Gastroesophageal reflux prophylaxis decreases the incidence of pharyngocutaneous fistula after total laryngectomy. Laryngoscope 1995;105:1220–2Google Scholar
10 Qureshi, SS, Chaturvedi, P, Pai, PS, Chaukar, DA, Deshpande, MS, Pathak, KA et al. A prospective study of pharyngocutaneous fistulas following total laryngectomy. J Cancer Res Ther 2005;1:51–6Google Scholar
11 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;124:1848–53CrossRefGoogle ScholarPubMed
12 Dudley, H, Carter, D, Russel, R, McGregor, I, Howard, D, eds. Rob & Smith's Operative Surgery, 4th edn. London: Butterworth-Heinemann, 1992 Google Scholar
13 Teknos, TN, Myers, LL. Surgical reconstruction after chemotherapy or radiation. Problems and solutions. Hematol Oncol Clin North Am 1999;13:679–87Google Scholar
14 Withrow, KP, Rosenthal, EL, Gourin, CG, Peters, GE, Magnuson, JS, Terris, DJ et al. Free tissue transfer manage salvage laryngectomy defects after organ preservation failure. Laryngoscope 2007;117:781–4Google Scholar
15 Fung, 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
16 Higgins, KM, Ashford, B, Erovic, BM, Yoo, J, Enepekides, DJ. Temporoparietal fascia free flap for pharyngeal coverage after salvage total laryngectomy. Laryngoscope 2012;122:523–7Google Scholar
17 Albirmawy, OA. Prevention of post laryngectomy pharyngocutaneous fistula using a sternocleidomastoid muscle collar flap. J Laryngol Otol 2007;121:253–7Google Scholar
18 Kadota, H, Fukushima, J, Kamizono, K, Masuda, M, Tanaka, S, Yoshida, T et al. A minimally invasive method to prevent postlaryngectomy major pharyngocutaneous fistula using infrahyoid myofascial flap. J Plast Reconstr Aesthet Surg 2013;66:906–11Google Scholar
19 Smith, TJ, Burrage, KJ, Ganguly, P, Kirby, S, Drover, C. Prevention of postlaryngectomy pharyngocutaneous fistula: the Memorial University experience. J Otolaryngol 2003;32:222–5Google Scholar
20 Patel, UA, Keni, SP. Pectoralis myofascial flap during salvage laryngectomy prevents pharyngocutaneous fistula. Otolaryngol Head Neck Surg 2009;141:190–5Google Scholar
21 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
22 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;132:778–82Google Scholar
23 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;139:1156–62Google Scholar
24 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
25 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
26 Rothmeier, N, Bergmann, C, Mattheis, S, Weller, P, Lang, S. The primary use of pectoralis myofascial flap in salvage laryngectomy. Laryngorhinootologie 2015;94:232–8Google Scholar
27 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
28 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
29 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
30 Sayles, M, Grant, DG. Preventing pharyngocutaneous fistula in total laryngectomy: a systematic review and meta-analysis. Laryngoscope 2014;124:1150–63Google Scholar
31 Sundaram, K, Wasserman, JM. Prevention of unplanned pharyngocutaneous fistula in salvage laryngectomy. Otolaryngol Head Neck Surg 2009;141:645–7Google Scholar