The role of pectoralis major myofascial flap in prevention of formation pharyngocutaneous fistula after total laryngectomy

AbstractObjective: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.

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Pectoralis Major Musculocutaneous Flap and Splitthickness Skin Graft for The Reconstruction of Pharyngocutaneous Fistula After Total Laryngeal Resection

Jurnal Plastik Rekonstruksi ◽

10.14228/jpr.v1i4.82 ◽

1970 ◽

Vol 1 (4) ◽

Author(s):

Parintosa Atmodiwirjo ◽

Sweety Pribadi

Keyword(s):

Conservative Management ◽

Total Laryngectomy ◽

Wound Dehiscence ◽

Early Postoperative Period ◽

Pedicled Flap ◽

Pectoralis Major ◽

Musculocutaneous Flap ◽

Pharyngocutaneous Fistula ◽

Surgical Closure ◽

Skin Island

Background: Pharyngocutaneous fistula (PCF) is the most frequent complication in the early postoperative period after total laryngectomy. Most PCF respond well to conservative management, but when it fails and the fistula persists surgical closure in indicated. Patients and Methods: Sixty-five year-old male was consulted to our division following total laryngectomy by the Ear Nose Throat surgeons, with wound dehiscence and pharyngocutaneous fistula. We performed a pectoralis major musculocutaneous flap (PMMCF) to close the fistula after a failed conservative management. The skin island of PMMCF was used as an inner lining to close the laryngeal fistula, the exteriorized muscle part of the "ap was then covered by skin graft.Results: PMMCF is a technically simple and reliable distant musculocutaneous pedicled flap to cover defect on the neck area. The skin island of the flap provided an adequate air-thight cover and successfully closed the laryngeal fistula.Summary: PCF is a problematic complication resulting from the resection of head and neck tumor. Early diagnosis and proper multidisciplinary management is required to prevent further morbidity. PMMCF is a simple, easy to perform and reliable option for closure of PCF.

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Faculty Opinions recommendation of Prophylactic pectoralis major muscle flap in prevention of pharyngocutaneous fistula in total laryngectomy after radiotherapy.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718378028.793509140 ◽

2015 ◽

Author(s):

Giulio Cantu ◽

Madia Pompilio ◽

Paolo Formillo

Keyword(s):

Total Laryngectomy ◽

Pectoralis Major Muscle ◽

Muscle Flap ◽

Pectoralis Major ◽

Pharyngocutaneous Fistula ◽

Pectoralis Major Muscle Flap

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The Role of Pectoralis Major Muscle Flap in Salvage Total Laryngectomy

Archives of Otolaryngology - Head and Neck Surgery ◽

10.1001/archoto.2009.126 ◽

2009 ◽

Vol 135 (10) ◽

pp. 1019 ◽

Cited By ~ 63

Author(s):

Ziv Gil ◽

Amar Gupta ◽

Ben Kummer ◽

Peter G. Cordeiro ◽

Dennis H. Kraus ◽

...

Keyword(s):

Total Laryngectomy ◽

Pectoralis Major Muscle ◽

Muscle Flap ◽

Pectoralis Major ◽

Pectoralis Major Muscle Flap

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Prevention of pharyngocutaneous fistula in salvage total laryngectomy: role of the pectoralis major flap and peri-operative management

The Journal of Laryngology & Otology ◽

10.1017/s0022215118000178 ◽

2018 ◽

Vol 132 (3) ◽

pp. 246-251 ◽

Cited By ~ 6

Author(s):

P Sittitrai ◽

C Srivanitchapoom ◽

D Reunmakkaew

Keyword(s):

Total Laryngectomy ◽

Operative Management ◽

Incidence Rates ◽

Pectoralis Major ◽

Control Group ◽

Pharyngocutaneous Fistula ◽

Pectoralis Major Flap ◽

Operative Care ◽

Fistula Rate ◽

The Impact

AbstractObjective:This study aimed to evaluate the impact of an onlay pectoralis major flap in reducing the incidence of pharyngocutaneous fistula after salvage total laryngectomy and determine the complications of pectoralis major flap reconstruction.Methods:A retrospective study was conducted of consecutive patients who underwent salvage total laryngectomy between 1995 and 2016. The pharyngeal defects were primarily closed with or without the pectoralis major flap.Results:Of 64 patients, 34 had primary pharyngeal closure alone (control group) and 30 received an onlay pectoralis major flap (pectoralis major flap group). The overall fistula rate was 15.6 per cent, with 17.6 per cent occurring in the control group and 13.3 per cent in the pectoralis major flap group (p = 0.74). The incidence rates of voice failure (p = 0.02) and shoulder disability (p < 0.001) were significantly higher in the pectoralis major flap group.Conclusion:The pectoralis major flap in salvage total laryngectomy did not decrease the pharyngocutaneous fistula rate, and the incidence of flap-related complications was high. Appropriate surgical technique and post-operative care may reduce the incidence of pharyngocutaneous fistula.

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