Abstract
Salvage laryngectomy in patients treated with organ preservation protocols is associated with high rates of postoperative complications. The use of non-irradiated tissue flaps in pharyngeal reconstruction could reduce the incidence of these complications.Objective: This study aims to evaluate the usefulness of the pectoralis major myocutaneous flap in preventing salivary fistulae during the postoperative period of salvage total laryngectomy (TL).Materials and Method: This retrospective study enrolled 31 patients operated between April of 2006 and May of 2011. All patients had advanced cancer at the time of the salvage procedure and had been treated with chemoradiotherapy or radiotherapy alone. Pharyngeal reconstruction was performed using pectoralis major myocutaneous flap in 19 cases (61%); primary wound closure occurred in 12 patients (39%).Results: Salivary fistulae occurred in 16% of the patients who received the flap and in 58% of the patients with primary closure of the pharynx (p < 0.02). No statistically significant differences were noted between the groups with respect to the mean time for fistula formation, reintroduction of an oral diet, or use of a nasoenteric tube for feeding.Conclusion: The pectoralis major myocutaneous flap was found to reduce the incidence of salivary fistulae in salvage laryngectomy procedures.
Highlights
The treatment of head and neck squamous cell carcinoma (SCC) has changed substantially in the last few years[1]
Salivary fistulae occurred in 16% of the patients who received the flap and in 58% of the patients with primary closure of the pharynx (p < 0.02)
The pectoralis major myocutaneous flap was found to reduce the incidence of salivary fistulae in salvage laryngectomy procedures
Summary
The treatment of head and neck squamous cell carcinoma (SCC) has changed substantially in the last few years[1]. Despite the efficacy of chemoradiotherapy, a considerable number of patients still require salvage surgery - usually in the form of total laryngectomy - when the disease persists or recurs[5,6]. Pharyngocutaneous fistulas - the most common post-laryngectomy complication - occur more frequently in this population and may affect more than 50% of the patients[8]. This complication leads to increased morbidity, prolonged hospitalization, and greater hospital care expenditure[9,10]. The same happens to patients with early recurring laryngeal tumors after radiotherapy alone[5,6]
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