Skip to main content Accessibility help
×
Home

Pectoralis major myofascial flap in salvage laryngectomy

  • E Cömert (a1), Ü Tunçel (a1), M Taner Torun (a2), C Kiliç (a3), A Buğra Cengiz (a1), Z şencan (a1) and M Kaya (a1)...

Abstract

Objective:

The main purpose of this study was to evaluate the effect of the pectoralis major myofascial flap on pharyngocutaneous fistula formation and time to oral feeding.

Methods:

This retrospective study reviewed 155 total laryngectomies. Patients were divided into two main groups. Group 1 included 110 patients who were treated primarily by total laryngectomy and group 2 comprised 45 patients who were treated by salvage laryngectomy with or without a pectoralis major myofascial flap.

Results:

The use of a pectoralis major myofascial flap did not have a significant effect on pharyngocutaneous fistula formation in the salvage group (p = 0.376). When comparing the oral feeding day of patients with pharyngocutaneous fistula, a significant difference was observed between the salvage group with pectoralis major myofascial flap reinforcement and the salvage group without pectoralis major myofascial flap reinforcement (p = 0.004).

Discussion:

Our study demonstrated that pectoralis major myofascial flap reinforcement did not decrease the rate of pharyngocutaneous fistula formation. Instead, it prevented the formation of large fistulas that would require surgical management, and showed a similar time to oral feeding and length of hospital stay to primary laryngectomy.

Copyright

Corresponding author

Address for correspondence: Dr Ela CömertAnkara Oncology Education and Research Hospital, Mehmet Akif Ersoy mah., 06200, Yenimahalle, AnkaraTurkey Fax: +90 312 345 49 79 E-mail: elacomert@yahoo.com

References

Hide All
1Rosai, J. Ackerman's Surgical Pathology, 8th edn.St Louis: Mosby, 1996;319–23
2Gillison, ML, Forastiere, AA. Larynx preservation in head and neck cancers. A discussion of the National Comprehensive Cancer Network Practice Guidelines. Hematol Oncol Clin North Am 1999;13:699718
3Hoffman, HT, McCulloch, T, Gustin, D, Karnell, LH. Organ preservation therapy for advanced-stage laryngeal carcinoma. Otolaryngol Clin North Am 1997;30:113–30
4Moyer, JS, Wolf, GT, Bradford, CR. Current thoughts on the role of chemotherapy and radiation in advanced head and neck cancer. Curr Opin Otolaryngol Head Neck Surg 2004;12:82–7
5Withrow, KP, Rosenthal, EL, Gourin, CG, Peters, GE, Magnuson, JS, Terris, DJ et al. Free tissue transfer to manage salvage laryngectomy defects after organ preservation failure. Laryngoscope 2007;117:781–4
6Davidson, BJ, Newkirk, KA, Harter, KW, Picken, CA, Cullen, KJ, Sessions, RB. Complications from planned, posttreatment neck dissections. Arch Otolaryngol Head Neck Surg 1999;125:401–5
7Sassler, AM, Esclamado, RM, Wolf, GT. Surgery after organ preservation therapy. Analysis of wound complications. Arch Otolaryngol Head Neck Surg 1995;121:162–5
8Gil, Z, Gupta, A, Kummer, B, Cordeiro, PG, Kraus, DH, Shah, JP et al. The role of pectoralis major muscle flap in salvage total laryngectomy. Arch Otolaryngol Head Neck Surg 2009;135:1019–23
9Applebaum, EL, Levine, HL. Pharyngeal reconstruction after laryngectomy. Laryngoscope 1977;87:1884–90
10Berry, SM, Fischer, JE. Classification and pathophysiology of enterocutaneous fistulas. Surg Clin North Am 1996;76:1009–18
11Celikkanat, S, Koç, C, Akyol, MU, Ozdem, C. Effect of blood transfusion on tumor recurrence and postoperative pharyngocutaneous fistula formation in patients subjected to total laryngectomy. Acta Otolaryngol 1995;115:566–8
12Sousa, AA, Castro, SM, Porcaro-Salles, JM, Soares, JM, de Moraes, GM, Carvalho, JR et al. The usefulness of a pectoralis major myocutaneous flap in preventing salivary fistulae after salvage total laryngectomy. Braz J Otorhinolaryngol 2012;78:103–7
13Tsou, YA, Hua, CH, Lin, MH, Tseng, HC, Tsai, MH, Shaha, A. Comparison of pharyngocutaneous fistula between patients followed by primary laryngopharyngectomy and salvage laryngopharyngectomy for advanced hypopharyngeal cancer. Head Neck 2010;32:1494–500
14Ariyan, S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg 1979;63:7381
15Paydarfar, JA, Birkmeyer, NJ. Complications in head and neck surgery: A meta-analysis of postlaryngectomy pharyngocutaneous fistula. Arch Otolaryngol Head Neck Surg 2006;132:6772
16Gooi, Z, Richmon, J. Long-term oral intake through a salivary bypass tube with chronic pharyngocutaneous fistula. Am J Otolaryngol 2012;33:762–3
17Ganly, I, Patel, S, Matsuo, J, Singh, B, Kraus, D, Boyle, J et al. Postoperative complications of salvage total laryngectomy. Cancer 2005;103:2073–81
18Weber, RS, Berkey, BA, Forastiere, A, Cooper, J, Maor, M, Goepfert, H et al. Outcome of salvage total laryngectomy following organ preservation therapy: The Radiation Therapy Oncology Group trial 91-11. Arch Otolaryngol Head Neck Surg 2003;129:44–9
19White, HN, Golden, B, Sweeny, L, Carroll, WR, Magnuson, JS, Rosenthal, EL. Assessment and incidence of salivary leak following laryngectomy. Laryngoscope 2012;122:1796–9
20Patel, UA, Keni, SP. Pectoralis myofascial flap during salvage laryngectomy prevents pharyngocutaneous fistula. Otolaryngol Head Neck Surg 2009;141:190–5
21Hanasono, MM, Lin, D, Wax, MK, Rosenthal, EL. Closure of laryngectomy defects in the age of chemoradiation therapy. Head Neck 2012;34:580–8
22Furuta, Y, Homma, A, Oridate, N, Suzuki, F, Hatakeyama, H, Suzuki, K et al. Surgical complications of salvage total laryngectomy following concurrent chemoradiotherapy. Int J Clin Oncol 2008;13:521–7
23Milenović, A, Virag, M, Uglesić, V, Aljinović-Ratković, N. The pectoralis major flap in head and neck reconstruction: First 500 patients. J Craniomaxillofac Surg 2006;34:340–3
24Righini, C, Lequeux, T, Cuisnier, O, Morel, N, Reyt, E. The pectoralis myofascial flap in pharyngolaryngeal surgery after radiotherapy. Eur Arch Otorhinolaryngol 2005;262:357–61
25Smith, TJ, Burrage, KJ, Ganguly, P, Kirby, S, Drover, C. Prevention of postlaryngectomy pharyngocutaneous fistula: The Memorial University experience. J Otolaryngol 2003;32:222–5

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed