Use of the Latissimus Dorsi Myocutaneous Island Flap for Reconstruction in the Head and Neck Area (original) (raw)
Related papers
Pectoralis major flap in the reconstruction after salvage laryngectomy
The Egyptian Journal of Otolaryngology
En Introduction Patients undergoing salvage surgery are more prone to developing pharyngocutaneous fistulas, the fistula rates reported are as high as 70%. Aim of the study The aim of this study was to present our experiences with patients undergoing reconstruction with a pectoralis major flap. Methods We describe the surgical steps we employed during the reconstruction after salvage laryngectomy in 14 consecutive patients. Discussion This flap will give the patient the advantages of early oral feeding, good tracheostomy care, short hospital stay, and protection against catastrophic vascular blowouts.
The Role of Pectoralis Major Muscle Flap in Salvage Total Laryngectomy
Archives of Otolaryngology–Head & Neck Surgery, 2009
The study included 461 patients who underwent laryngectomy. Eighty of them underwent salvage surgery with primary pharyngeal closure. Interventions: Of the 80 patients, 69 (86%) underwent primary pharyngeal closure alone and 11 (14%) underwent a PMMF, which was used to buttress the pharyngeal suture line. Main Outcome Measure: Two hundred thirty-six variables were recorded for each patient. Complications related to pharyngeal closure were measured. Results: Sixty-four percent of the patients who underwent PMMF also underwent chemoradiation therapy as the initial definitive treatment compared with 25% in the non-PMMF group (P=.03). On multivariate analysis, chemoradiation therapy was the only independent predictor of pharyngocutaneous fistula formation (relative risk, 1.82; P=.02). Nevertheless, the pharyngocutaneous fistula rate was similar in the PMMF (27%) and the non-PMMF (24%) groups. Furthermore, similar durations of tube feeding, days to oral feeding, and hospitalization period were recorded in both groups. Conclusion: The PMMF should be used judiciously as a surgical adjunct in high-risk patients, with the goal of minimizing the risk for the development of a pharyngocutaneous fistula.
Repair of post-laryngectomy pharyngocutaneous fistulae by muscle flaps
Indian Journal of Otolaryngology and Head & Neck Surgery, 1996
A muscle flap was utilized for repair of pharyngocutaneous fistulae following total laryngectomy after irradiation in ten cases. A sternocleidomastoid flap was used in four cases with a type I fistula. In two of these the investing fascia over the muscle was utilized for supplementing mucosal closure. A pectoralis major muscle flap was utilized in six patients with a type II or Ill fistula. The fistula healed in all cases. Technical details and one illustrative case are described.
Salvage total laryngectomy: is a flap necessary?
Brazilian Journal of Otorhinolaryngology, 2018
Introduction: Pharyngocutaneous fistula is the most significant complication after salvage total laryngectomy in patients who have received previous treatment with radiotherapy with or without chemotherapy. Objective: Our purpose is to review the fistula rate in radiated patients undergoing salvage total laryngectomy, to determine if the use of pectoralis major flap interposition reduces the incidence and duration of fistula and to examine other risk factors. Methods: We made a retrospective review of patients undergoing salvage total laryngectomy for exclusively larynx cancer after failure of primary curative radiotherapy between 2000 and 2017. General data from patients, risk factors and other complications were analyzed. Results: We identified 27 patients whose mean age was 66.4 years, mainly male (92.5%). The primary closure group without pectoralis major flap included 14 patients, and the group with pectoralis major flap closure included 13 patients. Pharyngocutaneous fistula was present in 15 patients (55.5%). Global pharyngocutaneous fistula rate was higher in the group of patients without pectoralis major flap comparing with those were the flap was interposed (78.6% versus 30.8%, p = 0.047). Also the pharyngocutaneous fistulas which need to be repaired with surgery (64.3% versus 7.7%, p = 0.03) and large pharyngostomes (64.3% versus 0%, p = 0.0004) were present in a higher rate in the group closed primary without pectoralis major flap. We did not find other risk factors with statistical significance. Oral diet initiation (84 days versus 21.5 days, p = 0.039) and the duration of hospitalization (98.3 days versus 27.2 days, p = 0.0041) were much lower in patients with a preventive pectoralis major flap. Tw o patients died as a consequence of complications of large pharyngostomes.
Background: Pharyngocutaneous stula (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 stula persists surgical closure in indicated. Patients and Methods: Sixty-ve year-old male was consulted to our division following total laryngectomy by the Ear Nose Throat surgeons, with wound dehiscence and pharyngocutaneous stula. We performed a pectoralis major musculocutaneous ap (PMMCF) to close the stula after a failed conservative management. The skin island of PMMCF was used as an inner lining to close the laryngeal stula, the exteriorized muscle part of the ap was then covered by skin graft. Results: PMMCF is a technically simple and reliable distant musculocutaneous pedicled ap to cover defect on the neck area. The skin island of the ap provided an adequate air-thight cover and successfully closed the laryngeal stula. 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.
Impact of Pharyngeal Closure Technique on Fistula After Salvage Laryngectomy
JAMA Otolaryngology–Head & Neck Surgery, 2013
IMPORTANCE No consensus exists as to the best technique, or techniques, to optimize wound healing, decrease pharyngocutaneous fistula formation, and shorten both hospital length of stay and time to initiation of oral intake after salvage laryngectomy. We sought to combine the recent experience of multiple high-volume institutions, with different reconstructive preferences, in the management of pharyngeal closure technique for post-radiation therapy salvage total laryngectomy in an effort to bring clarity to this clinical challenge. OBJECTIVE To determine if the use of vascularized flaps in either an onlay or interposed fashion reduces the incidence or duration of pharyngocutaneous fistula after salvage laryngectomy compared with simple primary closure of the pharynx. DESIGN Multi-institutional retrospective review of all patients undergoing total laryngectomy after having received definitive radiation therapy with or without chemotherapy between January 2005 and January 2012, conducted at 7 academic medical centers. SETTING Academic, tertiary referral centers. PATIENTS The study population comprised 359 patients from 8 institutions. All patients had a history of laryngeal irradiation and underwent laryngectomy between 2005 and 2012. They were grouped as primary closure, pectoralis myofascial onlay flap, or interposed free tissue. All patients had a minimum of 4 months follow-up. MAIN OUTCOMES AND MEASURES Fistula incidence, severity, and predictors of fistula. RESULTS Of the 359 patients, fistula occurred in 94 (27%). For patients with fistula, hospital stay increased from 8.9 to 12.1 days (P < .001) and oral diet initiation was delayed from 10.5 days to 29.9 days (P < .001). Patients were grouped according to closure technique: primary closure (n = 99), pectoralis onlay flap (n = 40), and interposed free tissue (n = 220). Incidence of fistula with primary closure was 34%. For the interposed free flap group, the fistula rate was lower at 25% (P = .07). Incidence of fistula was the lowest for the pectoralis onlay group at 15% (P = .02). Multivariate analysis confirmed a significantly lower fistula rate with either flap technique. For patients who developed fistula, mean duration of fistula was significantly prolonged with primary closure (14.0 weeks) compared with pectoralis flap (9.0 weeks) and free flap (6.5 weeks). CONCLUSIONS AND RELEVANCE Pharyngocutaneous fistula remains a significant problem following salvage laryngectomy. Use of nonirradiated, vascularized flaps reduced the incidence and duration of fistula and should be considered during salvage laryngectomy.
Head & neck, 2014
Background. The purpose of this study was to assess the utility of the pectoralis major muscle flap (PMMF) in the prevention of pharyngocutaneous fistula for total laryngectomy after radiotherapy (RT) Methods. We conducted a retrospective review of 166 patients who underwent a total laryngectomy after RT between 1998 and 2012 at the CHU de Qu ebec. Results. One hundred fifteen patients underwent a total laryngectomy with primary pharyngeal closure alone and 51 patients received an onlay PMMF. The incidence of pharyngocutaneous fistula in the PMMF group was 14% compared to 36% when only primary closure was done (p 5 .004). However, the PMMF did not influence the treatment needed for the healing of this complication (p 5 1.00). The development of pharyngocutaneous fistula increased the length of stay from 19 to 50 days (p < .0001) and delayed the initiation of oral diet from 15 to 25 days (p 5 .03). Conclusion. Nonirradiated tissue coverage should be routine in total laryngectomy after RT. PMMF is a good adjunct to prevent pharyngocutaneous fistula. V