Fasciocutaneous free flaps for reconstruction of hypopharyngeal defects.

Cesare Piazza,Alberto Paderno,Nausica Montalto,Francesca Del Bon,Valentina Taglietti,Piero Nicolai,Alberto Grammatica

doi:10.1002/lary.26705

Abstract

Different reconstructive options are available for defects following total laryngectomy (TL) and circumferential (CH) or partial hypopharyngectomy (PH). We evaluated the flap success, pharyngocutaneous fistula, and pharyngoesophageal stenosis rates in two groups of patients treated by different policies. Comparison between two cohorts of patients treated by TL with PH/CH ± cervical esophagectomy and reconstructed according to different strategies. Group A (historical) was composed of 89 patients reconstructed by pectoralis major myocutaneous (PMMC), radial forearm (RF), and anterolateral thigh (ALT) flaps. A salivary bypass stent (SBPS) was not routinely applied and left in place for a maximum of 14 days. Forty-four (49%) patients received preoperative radiotherapy/chemoradiotherapy (RT/CRT). Group B (prospective) included 105 patients reconstructed by RF or ALT with long-lasting SBPS left in place for a maximum of 45 days. Sixty-one (59%) received preoperative RT/CRT. In group A, flap failure occurred in four (4%) cases, and all were managed by PMMC. We encountered 22 (26%) fistulas and 14 (16%) stenoses. In group B, flap failure occurred in six (6%) cases and was managed by PMMC. We encountered seven (7%) fistulas and three (3%) stenoses. Comparing complications among the two groups, we encountered a statistically significant difference in favor of group B for both fistula (P < .001) and stenosis (P = .001). We did not evidence any significant difference in terms of flap success rate. First-line application of RF and ALT free flaps with long-lasting SBPS in reconstruction after PH/CH allows obtaining reduced incidences of both fistula and stenosis. 4. Laryngoscope, 127:2731-2737, 2017.

Highlights

Reconstruction following laryngo-hypopharyngectomy for hypopharyngeal squamous cell carcinoma (HSCC) remains a challenge in head and neck surgical practice
Even in na€ıve HSCC to be treated by total laryngectomy (TL) with partial hypopharyngectomy (PH), this must be considered more the exception than the rule
This study is based on the comparison between two groups of patients submitted to TL and PH or circumferential hypopharyngectomy (CH) with/without cervical esophagectomy (CE) for pT3–T4 and rypT2–T4 HSCC followed by primary reconstruction at the Department of Otorhinolaryngology Head and Neck

Summary

Introduction

Reconstruction following laryngo-hypopharyngectomy for hypopharyngeal squamous cell carcinoma (HSCC) remains a challenge in head and neck surgical practice. The ideal reconstructive technique for such defects, possibly involving the cervical esophagus, should be that with the lowest ensuing morbidity (especially in terms of fistula and stricture rates) and mortality, as well as the most rapid and efficient swallowing rehabilitation. The minimum amount of healthy mucosa necessary to primarily close the neopharynx without excessive risk of pharyngocutaneous fistula (PCF) and/or postoperative stenosis is considered to be at least 2.5 cm.[1] even in na€ıve HSCC to be treated by total laryngectomy (TL) with partial hypopharyngectomy (PH), this must be considered more the exception than the rule. From the Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy.

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