Skip to main content Accessibility help

Role of the pectoralis major myofascial flap in preventing pharyngocutaneous fistula following salvage laryngectomy

  • S Sharma (a1), D A Chaukar (a1), S G Laskar (a2), N Kapre (a1), A Deshmukh (a1), P Pai (a1), P Chaturvedi (a1) and A D'Cruz (a1)...



This study aimed to assess the utility of onlay pectoralis major myofascial flap in preventing pharyngocutaneous fistula following salvage total laryngectomy.


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.


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).


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.


Corresponding author

Address for correspondence: Dr D Chaukar, 1226 Homi Bhabha Block, Dr E Borges Marg, Tata Memorial Hospital, Parel, Mumbai 400012, India Fax: +91 24146937 E-mail:


Hide All

Presented as an oral paper at the joint Fifth World Congress of the International Federation of Head and Neck Oncologic Society and 2014 Annual Meeting of the American Head and Neck Society, 29 July 2014, New York, USA



Hide All
1 The Department of Veterans Affairs Laryngeal Cancer Study Group. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med 1991;324:1685–90
2 Forastiere, AA, Goepfert, H, Maor, M, Pajak, TF, Weber, R, Morrison, W et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003;349:2091–8
3 Sassler, AM, Esclamado, RM, Wolf, GT. Surgery after organ preservation therapy. Analysis of wound complications. Arch Otolaryngol Head Neck Surg 1995;121:162–5
4 Johansen, LV, Overgaard, J, Elbrønd, O. Pharyngocutaneous fistulae after laryngectomy. Influence of previous radiotherapy and prophylactic metronidazole. Cancer 1988;61:673–8
5 Papazoglou, G, Doundoulakis, G, Terzakis, G, Dokianakis, G. Pharyngocutaneous fistula after total laryngectomy: incidence, cause, and treatment. Ann Otol Rhinol Laryngol 1994;103:801–5
6 Grau, C, Johansen, LV, Hansen, HS, Andersen, E, Godballe, C, Andersen, LJ et al. Salvage laryngectomy and pharyngocutaneous fistulae after primary radiotherapy for head and neck cancer: a national survey from DAHANCA. Head Neck 2003;25:711–16
7 Sarkar, S, Mehta, SA, Tiwari, J, Mehta, AR, Mehta, MS. Complications following surgery for cancer of the larynx and pyriform fossa. J Surg Oncol 1990;43:245–9
8 Aprigliano, F. Use of the nasogastric tube after total laryngectomy: is it truly necessary? Ann Otol Rhinol Laryngol 1990;99:513–14
9 Seikaly, H, Park, P. Gastroesophageal reflux prophylaxis decreases the incidence of pharyngocutaneous fistula after total laryngectomy. Laryngoscope 1995;105:1220–2
10 Qureshi, SS, Chaturvedi, P, Pai, PS, Chaukar, DA, Deshpande, MS, Pathak, KA et al. A prospective study of pharyngocutaneous fistulas following total laryngectomy. J Cancer Res Ther 2005;1:51–6
11 Paleri, V, Drinnan, M, van den Brekel, MW, Hinni, ML, Bradley, PJ, Wolf, GT et al. Vascularized tissue to reduce fistula following salvage total laryngectomy: a systematic review. Laryngoscope 2014;124:1848–53
12 Dudley, H, Carter, D, Russel, R, McGregor, I, Howard, D, eds. Rob & Smith's Operative Surgery, 4th edn. London: Butterworth-Heinemann, 1992
13 Teknos, TN, Myers, LL. Surgical reconstruction after chemotherapy or radiation. Problems and solutions. Hematol Oncol Clin North Am 1999;13:679–87
14 Withrow, KP, Rosenthal, EL, Gourin, CG, Peters, GE, Magnuson, JS, Terris, DJ et al. Free tissue transfer manage salvage laryngectomy defects after organ preservation failure. Laryngoscope 2007;117:781–4
15 Fung, K, Teknos, TN, Vandenberg, CD, Lyden, TH, Bradford, CR, Hogikyan, ND et al. Prevention of wound complications following salvage laryngectomy using free vascularized tissue. Head Neck 2007;29:425–30
16 Higgins, KM, Ashford, B, Erovic, BM, Yoo, J, Enepekides, DJ. Temporoparietal fascia free flap for pharyngeal coverage after salvage total laryngectomy. Laryngoscope 2012;122:523–7
17 Albirmawy, OA. Prevention of post laryngectomy pharyngocutaneous fistula using a sternocleidomastoid muscle collar flap. J Laryngol Otol 2007;121:253–7
18 Kadota, H, Fukushima, J, Kamizono, K, Masuda, M, Tanaka, S, Yoshida, T et al. A minimally invasive method to prevent postlaryngectomy major pharyngocutaneous fistula using infrahyoid myofascial flap. J Plast Reconstr Aesthet Surg 2013;66:906–11
19 Smith, TJ, Burrage, KJ, Ganguly, P, Kirby, S, Drover, C. Prevention of postlaryngectomy pharyngocutaneous fistula: the Memorial University experience. J Otolaryngol 2003;32:222–5
20 Patel, UA, Keni, SP. Pectoralis myofascial flap during salvage laryngectomy prevents pharyngocutaneous fistula. Otolaryngol Head Neck Surg 2009;141:190–5
21 Oosthuizen, JC, Leonard, DS, Kinsella, JB. The role of pectoralis major myofascial flap in salvage laryngectomy: a single surgeon experience. Acta Otolaryngol 2012;132:1002–5
22 Sakai, A, Okami, K, Sugimoto, R, Ebisumoto, K, Yamamoto, H, Maki, D et al. Prevention of wound complications in salvage pharyngolaryngectomy by the use of well-vascularized flaps. Acta Otolaryngol 2012;132:778–82
23 Patel, UA, Moore, BA, Wax, M, Rosenthal, E, Sweeny, L, Militsakh, ON et al. Impact of pharyngeal closure technique on fistula after salvage laryngectomy. JAMA Otolaryngol Head Neck Surg 2013;139:1156–62
24 Gendreau-Lefèvre, AK, Audet, N, Maltais, S, Thuot, F. Prophylactic pectoralis major muscle flap in prevention of pharyngocutaneous fistula in total laryngectomy after radiotherapy. Head Neck 2015;37:1233–8
25 Gilbert, MR, Sturm, JJ, Gooding, WE, Johnson, JT, Kim, S. Pectoralis major myofascial onlay and myocutaneous flaps and pharyngocutaneous fistula in salvage laryngectomy. Laryngoscope 2014;124:2680–6
26 Rothmeier, N, Bergmann, C, Mattheis, S, Weller, P, Lang, S. The primary use of pectoralis myofascial flap in salvage laryngectomy. Laryngorhinootologie 2015;94:232–8
27 Righini, 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
28 Gil, 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
29 Cömert, E, Tunçel, Ü, Torun, MT, Kiliç, C, Cengiz, AB, Sencan, Z et al. Pectoralis major myofascial flap in salvage laryngectomy. J Laryngol Otol 2014;128:714–19
30 Sayles, M, Grant, DG. Preventing pharyngocutaneous fistula in total laryngectomy: a systematic review and meta-analysis. Laryngoscope 2014;124:1150–63
31 Sundaram, K, Wasserman, JM. Prevention of unplanned pharyngocutaneous fistula in salvage laryngectomy. Otolaryngol Head Neck Surg 2009;141:645–7



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