Use of pectoralis major myofascial flap on the prevention of pharyngocutaneous fístula in salvage laryngectomy after chemoradiotherapy

Abstract

Background: Pharyngocutaneous fístula (PCF) is a major complication of salvage laryngectomies, mainly secondary to the effect of radiotherapy.Aims/objectives: Our main objective is to study the effect of pectoralis major myofascial flap (PMMF) on the prevention of PCF.Materials and methods: We studied all total laryngectomies (TL) performed between 2001 and 2018, noting the use of previous chemoradiation, the type of suture and the use of flaps. We recorded and compared the incidence of PCF in all groups.Results: A total of 146 patients were included, divided into a primary TL group (117 patients) and salvage TL (29 patients). PMMF was used in 62% of salvage TLs. The rates of PCF were 5.98% in primary TL and 17.2% in salvage procedures. Among the salvage TL group, in patients with pharyngeal closure alone, a PCF developed in 36.4% of cases, compared to 5.56% in the PMMF group. We found a similar rate of fistulae when comparing primary TL and salvage TL with PMMF, highlighting the protective effect of the flap.Conclusions and significance: The use of PMMF in salvage TL reduces the incidence of PCF, achieving a rate similar to that attained with primary TL.