1
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Williamson A, Shah F, Benaran I, Paleri V. Vascularized Tissue to Reduce Fistula After Salvage Total Laryngectomy: A Network Meta-analysis. Laryngoscope 2024; 134:2991-3002. [PMID: 38238878 DOI: 10.1002/lary.31287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE Salvage laryngectomy is more predisposed to complications than primary operations, with pharyngocutaneous fistula (PCF) being among the most challenging to manage. Vascularized flaps are increasingly employed during salvage laryngectomy, with a previous review finding a PCF incidence of 31.2% and 22.2% after primary and flap-assisted closure respectively. We aim to better define the role of vascularized flaps after salvage laryngectomy by performing an updated review comparing the rate of PCF in those undergoing primary or vascularized flap-assisted closure. DATA SOURCES Pubmed/Medline, CINAHL, and CENTRAL. REVIEW METHODS An updated literature review was conducted of English language literature from 2003 to 2023. A random effects and network meta-analysis of odds ratios (OR) and pooled proportions were conducted. RESULTS Literature search found 31 studies, including seven from the previous review. Overall random effects pooled PCF rate was 25% (95% CI 0.21; 0.30, I2 = 72%, p = <0.01), whereas incidence in primary closure was 37% (95% CI 0.32; 0.43, I2 = 60%, p = <0.01) and 19% (95% CI 0.12; 0.20, I2 = 47%, p = <0.01) after flap closure. Pooled OR was 0.39 (95% CI 0.28; 0.55, I2 = 36%, p = 0.04) in favor of vascularized tissues. The number needed to treat was 6.5. The rate of PCF was lower after free and pedicled flaps, and on-lay and patch closure compared to primary closure techniques. Network meta-analysis found all combinations of closure techniques and vascularized tissue were superior to primary closure. CONCLUSION The updated analysis has demonstrated a widening in the rates of PCF between primary and vascularized flap-assisted closure. Surgeons should strongly consider the use of free or pedicled flaps in any salvage laryngectomy procedure. Laryngoscope, 134:2991-3002, 2024.
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Affiliation(s)
- Andrew Williamson
- Department of Head and Neck Surgery, The Royal Marsden Hospital, International Centre for Recurrent Head and Neck Cancer (IReC), London, United Kingdom
- Institute for Cancer Research, London, United Kingdom
| | - Faizan Shah
- Department of Otolaryngology, Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Irene Benaran
- Department of Otolaryngology, Head and Neck Surgery, Monklands University Hospital, Glasgow, United Kingdom
| | - Vinidh Paleri
- Department of Head and Neck Surgery, The Royal Marsden Hospital, International Centre for Recurrent Head and Neck Cancer (IReC), London, United Kingdom
- Institute for Cancer Research, London, United Kingdom
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Zorlu ME, Kertmen C, Aysel A, Yilmaz F, Dalgic A, Muderris T. Use of Cervical Fascia to Prevent Pharyngocutaneus Fistula After Total Laryngectomy. Laryngoscope 2024. [PMID: 38940495 DOI: 10.1002/lary.31606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/23/2024] [Accepted: 06/11/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE This study aimed to compare the pharyngocutaneous fistula (PCF) between patients who underwent reconstruction using cervical fascia after total laryngectomy and those who did not and to investigate the factors affecting PCF rates. METHODS We retrospectively compared 22 patients operated between February 2021 and March 2023 who received cervical fascia flap as the study group and 21 patients operated between January 2018 and March 2023 who did not receive fascia flap as the control group. The study included patients who underwent total laryngectomy for Stage 3 and 4 squamous cell laryngeal cancer. RESULTS We included 43 patients, with 22 (51.2%) and 21 patients (48.8%) in the study and control groups, respectively. The age and sex were not different between the two groups (p = 0.471, p = 0.176, respectively). The distribution of patients as per sex, smoking, alcohol use, chronic obstructive pulmonary disease, diabetes mellitus, coronary artery disease, and multiple comorbidities was similar in both groups (p > 0.05). PCF was observed in one patient (4.5%) and seven patients (33.3%) in the study and control groups, respectively. The PCF rate was significantly lower in the study group (p = 0.021). When the relationship between flap use and risk factors was compared by correlation analysis, a moderate negative relationship was found between flap use and PCF (p = 0.015, r = -0.370). CONCLUSION The use of a cervical fascia flap is effective in reducing fistula rates after total laryngectomy. Its main advantages include being technically simpler than alternative techniques, locally available, cost-effective. LEVEL OF EVIDENCE Level 3 Laryngoscope, 2024.
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Affiliation(s)
- Mehmet Ekrem Zorlu
- Department of Otolaryngology and Head & Neck Surgery, Cigli Training and Research Hospital, Bakircay University Faculty of Medicine, Izmir, Turkey
- Department of Otolaryngology and Head & Neck Surgery, Izmir Bozyaka Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Canberk Kertmen
- Department of Otolaryngology and Head & Neck Surgery, Izmir Bozyaka Training and Research Hospital, University of Health Sciences, Izmir, Turkey
- Department of Otolaryngology and Head & Neck Surgery, Izmir Bayrakli City Hospital, Izmir, Turkey
| | - Abdulhalim Aysel
- Department of Otolaryngology and Head & Neck Surgery, Izmir Bozyaka Training and Research Hospital, University of Health Sciences, Izmir, Turkey
- Department of Otolaryngology and Head & Neck Surgery, Izmir Bayrakli City Hospital, Izmir, Turkey
| | - Fatih Yilmaz
- Department of Otolaryngology and Head & Neck Surgery, Izmir Bozyaka Training and Research Hospital, University of Health Sciences, Izmir, Turkey
- Department of Otolaryngology and Head & Neck Surgery, Izmir Bayrakli City Hospital, Izmir, Turkey
| | - Abdullah Dalgic
- Department of Otolaryngology and Head & Neck Surgery, Izmir Bozyaka Training and Research Hospital, University of Health Sciences, Izmir, Turkey
- Department of Otolaryngology and Head & Neck Surgery, Izmir Bayrakli City Hospital, Izmir, Turkey
| | - Togay Muderris
- Department of Otolaryngology and Head & Neck Surgery, Cigli Training and Research Hospital, Bakircay University Faculty of Medicine, Izmir, Turkey
- Department of Otolaryngology and Head & Neck Surgery, Izmir Bozyaka Training and Research Hospital, University of Health Sciences, Izmir, Turkey
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Marzi Manfroni A, Marvi MV, Lodi S, Breque C, Vara G, Ruggeri A, Badiali G, Manzoli L, Tarsitano A, Ratti S. Anatomical Study of the Application of a Galeo-Pericranial Flap in Oral Cavity Defects Reconstruction. J Clin Med 2023; 12:7533. [PMID: 38137603 PMCID: PMC10743416 DOI: 10.3390/jcm12247533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Oral cavity defects occur after resection of lesions limited to the mucosa, alveolar gum, or minimally affecting the bone. Aiming at esthetical and functional improvements of intraoral reconstruction, the possibility of harvesting a new galeo-pericranial free flap was explored. The objective of this study was to assess the technical feasibility of flap harvesting through anatomical dissections and surgical procedure simulations. Ten head and neck specimens were dissected to simulate the surgical technique and evaluate the vascular calibers of temporal and cervical vessels. The procedure was therefore reproduced on a revascularized and ventilated donor cadaver. Anatomical dissections demonstrated that the mean cervical vascular calibers are compatible with superficial temporal ones, proving to be adequate for anastomosis. Perforating branches of the superficial temporal vascularization nourishing the pericranium were identified in all specimens. In conclusion, blood flow presence was recorded after anastomosing superficial temporal and facial vessels in the revascularized donor cadaver, demonstrating both this procedure's technical feasibility and the potential revascularization of the flap and therefore encouraging its potential in vivo application.
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Affiliation(s)
- Alice Marzi Manfroni
- Oral and Maxillo-Facial Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (A.M.M.); (G.B.); (A.T.)
| | - Maria Vittoria Marvi
- Cellular Signalling Laboratory, Anatomy Centre, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy; (M.V.M.); (S.L.); (G.V.); (A.R.); (L.M.)
| | - Simone Lodi
- Cellular Signalling Laboratory, Anatomy Centre, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy; (M.V.M.); (S.L.); (G.V.); (A.R.); (L.M.)
| | - Cyril Breque
- Laboratoire d’Anatomie, Biomécanique et Simulation, UFR Medicine and Pharmacy, Bat D1-Porte J 6, Milétrie Street, TSA 51115, CEDEX 9, 86073 Poitiers, France;
| | - Giulio Vara
- Cellular Signalling Laboratory, Anatomy Centre, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy; (M.V.M.); (S.L.); (G.V.); (A.R.); (L.M.)
| | - Alessandra Ruggeri
- Cellular Signalling Laboratory, Anatomy Centre, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy; (M.V.M.); (S.L.); (G.V.); (A.R.); (L.M.)
| | - Giovanni Badiali
- Oral and Maxillo-Facial Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (A.M.M.); (G.B.); (A.T.)
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy
| | - Lucia Manzoli
- Cellular Signalling Laboratory, Anatomy Centre, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy; (M.V.M.); (S.L.); (G.V.); (A.R.); (L.M.)
| | - Achille Tarsitano
- Oral and Maxillo-Facial Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (A.M.M.); (G.B.); (A.T.)
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy
| | - Stefano Ratti
- Cellular Signalling Laboratory, Anatomy Centre, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy; (M.V.M.); (S.L.); (G.V.); (A.R.); (L.M.)
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4
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De Virgilio A, Costantino A, Festa BM, Russo E, Malvezzi L, Pellini R, Colombo G, Spriano G, Mercante G, Ferreli F. Surgical prevention of pharyngocutaneous fistula in salvage total laryngectomy: a systematic review and network meta-analysis. Eur Arch Otorhinolaryngol 2022; 279:5839-5849. [PMID: 35731297 DOI: 10.1007/s00405-022-07490-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/05/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE To compare the efficacy of different reconstructive techniques in preventing pharyngocutaneous fistula (PCF) after salvage total laryngectomy (STL). METHODS An arm-based network analysis was conducted using a Bayesian hierarchical model according to the PRISMA-NMA guidelines. RESULTS A total of 1694 patients with a median age of 64 years (n = 1569, 95% CI: 62-66 years) were included. If compared to primary pharyngeal closure alone, only a pedicled flap onlay (PFO) showed a statistically significant reduction in PCF rate (OR: 0.35, CI: 0.20-0.61). PFO seemed to perform better than other treatments according to the rank probabilities test (39.9% chance of ranking first). CONCLUSIONS A pedicled flap placed with an overlay technique might be preferred over a patch reconstruction to prevent PCF after STL.
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Affiliation(s)
- Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Bianca Maria Festa
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy. .,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Elena Russo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Luca Malvezzi
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Raul Pellini
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Giovanni Colombo
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
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5
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Locatello LG, Licci G, Maggiore G, Gallo O. Non-Surgical Strategies for Assisting Closure of Pharyngocutaneous Fistula after Total Laryngectomy: A Systematic Review of the Literature. J Clin Med 2021; 11:jcm11010100. [PMID: 35011841 PMCID: PMC8745591 DOI: 10.3390/jcm11010100] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Pharyngocutaneous fistula (PCF) is a frequent complication after total laryngectomy, with an incidence of up to 65%. Many conservative or invasive approaches are available and the choice among them is usually made on a case-by-case basis. The aim of the present review is to critically summarize the available evidence of the effectiveness of the non-surgical management of PCF. Methods: A systematic review and a meta-analysis of the literature were conducted, according to the PRISMA guidelines. Studies investigating botulinum toxin therapy, scopolamine transdermal patch, hyperbaric oxygen therapy (HBOT), and negative pressure wound therapy (NPWT) were assessed. Complete fistula closure after the initiation of non-surgical treatment was the main outcome. Results: After the application of selection criteria, a total of seven articles and 27 patients were included in the present review. All the eligible studies were descriptive case series, while only one article used a standard group as a comparison. The mean age was 63.3 and 14 patients (51.9%) had previously received RT. The reported comorbidities were diabetes, ischemic heart disease, hypertension, dyslipidemia, COPD, and atrial fibrillation. With a mean healing time of 25.0 days, the overall success rate was 92.6%. Conclusions: Non-surgical treatment of PCF is only based on the experience of small series. Although success rates seem promising, the absence of properly designed comparative studies does not allow us, at present, to identify ideal candidates for these non-invasive management strategies for PCF.
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Affiliation(s)
- Luca Giovanni Locatello
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134 Florence, Italy; (G.L.); (G.M.); (O.G.)
- Correspondence: ; Tel.: +39-055-7947989
| | - Giuseppe Licci
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134 Florence, Italy; (G.L.); (G.M.); (O.G.)
| | - Giandomenico Maggiore
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134 Florence, Italy; (G.L.); (G.M.); (O.G.)
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134 Florence, Italy; (G.L.); (G.M.); (O.G.)
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
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6
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Mattioli F, Fermi M, Martone A, Ghirelli M, Giordano L, Di Santo D, Bussi M, Presutti L. Supraclavicular artery fascial flap (SAFF): a valuable tool in salvage total laryngectomy and hemipharyngolaryngectomy. ACTA OTORHINOLARYNGOLOGICA ITALICA 2021; 41:523-529. [PMID: 34825667 PMCID: PMC8686805 DOI: 10.14639/0392-100x-n1152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 06/26/2021] [Indexed: 11/23/2022]
Abstract
Objective To describe the surgical technique of the supraclavicular artery fascial flap (SAFF) and outcomes in neopharyngeal covering with overlay technique during salvage total laryngectomy for residual or recurrent carcinoma after chemo/radiation treatment. Methods Chart review of patients treated between October 2018 and February 2019 at two tertiary care hospitals. Variables extracted from patient records were age, gender, history of chemo/radiation therapy, neck dissection, surgical and postoperative complications. Outcomes measured were surgical time, postoperative complications and flap failure, oral intake start and patient discharge. Results Ten male patients were included. Median age was 64 years. All patients underwent salvage total laryngectomy and neopharyngeal covering with SAFF. Mean flap harvest time was 25 minutes. No surgical complications or flap failure were recorded. Oral intake was started on a median of post-operative day 10. No cases of pharyngocutaneous fistula were encountered. Conclusions SAFF is a reliable, easy and quick to harvest flap, which provides a good alternative to other pedicled and free flaps for hypopharyngeal coverage in laryngeal salvage surgery. Donor site morbidity is almost null and postoperative complications are very rare.
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7
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Horen SR, Hamidian Jahromi A, Konofaos P. Temporoparietal Fascial Free Flap: A Systematic Review. Ann Plast Surg 2021; 87:e189-e200. [PMID: 34387574 DOI: 10.1097/sap.0000000000002961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The temporoparietal fascial flap (TPFF) is a versatile tool used in head and neck reconstructive surgeries as well as distal upper and lower extremity reconstructions. Depending on the anatomical location and characteristics of the recipient site soft tissue defects, harvesting techniques for TPFF retrieval may include elevation as a pedicle or a free flap, inclusion of the temporalis muscle and/or adjacent calvarial bone as a composite flap. The TPFF as a free flap is not only used for soft tissue coverage of various defects, and it can be used as a joint gliding surface with coverage of nerve and tendons after repair or trauma. This article includes a systematic search of the medical literature for indications, historical background, techniques, current perspective, and complications along with the pros and cons of the free TPFF compared with other potential reconstructive options.
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Affiliation(s)
- Sydney R Horen
- From the Department of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL
| | - Alireza Hamidian Jahromi
- From the Department of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL
| | - Petros Konofaos
- Department of Plastic Surgery, University of Tennessee Health Science Center (UTHSC), Memphis, TN
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8
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Bathula SS, Stern NA, Ross A, Patrick T, Talatala ER. Role of Pectoralis Major Myocutaneous Flap in Laryngectomy Surgery: Single Surgeon Experience. Cureus 2021; 13:e18198. [PMID: 34722018 PMCID: PMC8544620 DOI: 10.7759/cureus.18198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To analyze the effectiveness of the pectoralis major myocutaneous (PMMC) flap in preventing pharyngocutaneous fistula (PCF) formation for salvage total laryngectomy patients. Study design Retrospective chart review of all post-surgical laryngectomy patients for a single surgeon. Methods Inclusion criteria were adult patients 18 years and older who were diagnosed with laryngeal cancer and treated with a salvage total laryngectomy. Exclusion criteria were any laryngectomy patient treated without the PMMC flap or those with incomplete medical records. Results A total of 31 patient charts were identified, and 16 remained after exclusion criteria. The patient age range was 42-71 years (mean = 58.19; SD = 8.093). Greater than 85% of patients had T3 and T4 laryngeal cancers. Without PCF group were 13 patients and with PCF group were only three patients. The mean hospital days in without PCF group were 9.54 and in with PCF group were 16.33. Conclusion In this single surgeon’s experience, PCF was prevented by using the PMMC flap in salvage total laryngectomy patients.
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Affiliation(s)
- Samba Siva Bathula
- Otolaryngology, Michigan State University/Detroit Medical Center, Detroit, USA
| | - Noah A Stern
- Otolaryngology, Detroit Medical Center, Detroit, USA
| | - Andrew Ross
- Otolaryngology - Head and Neck Surgery, Detroit Medical Center, Detroit, USA
| | - Tyler Patrick
- Otolaryngology, Detroit Medical Center, Detroit, USA
| | - Edward R Talatala
- Otolaryngology - Head and Neck Surgery, Meharry Medical College, Detroit, USA
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Do Salivary Bypass Tubes Reduce the Risk of Pharyngocutaneous Fistula after Laryngopharyngectomy-A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13112827. [PMID: 34204054 PMCID: PMC8201015 DOI: 10.3390/cancers13112827] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 01/12/2023] Open
Abstract
Simple Summary Salivary bypass tubes (SBT) have been introduced in order to reduce the risk of pharyngocutaneous fistula (PCF) after laryngectomy with pharynx reconstruction. Although the current literature is rather heterogenous, our meta-analysis demonstrates a favorable effect of SBT insertion on PCF formation in patients after laryngopharyngectomies. Abstract To evaluate the effect of salivary bypass tube (SBT) usage on the occurrence of pharyngocutaneous fistula (PCF) in patients after a laryngopharyngectomy, a total of 20 studies, published between 1988 and 2021, were identified including 2946 patients. We performed a meta-analysis assessing the risk of PCF occurrence in patients after SBT application compared to those without. PCF occurred in 26.8% of cases (669/2496) and SBT was applied in 33.0% of patients (820/2483). There was an overall trend towards lower PCF rates when using SBTs (22.2% vs. 35.3%; p = 0.057). We further selected five studies, comprising 580 patients who underwent laryngopharyngectomies, for meta-analysis showing that application of SBT reduced the risk of PCF formation (OR 0.46; 95% CI 0.18–1.18; p = 0.11). The meta-analysis demonstrates a beneficial effect of SBT insertion on PCF formation in patients after laryngopharyngectomy.
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10
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Pellini R, Zocchi J, Pichi B, Manciocco V, Marchesi P, Sperduti I, Mercante G, Molteni G, Iocca O, Di Maio P, De Virgilio A, Vidiri A, Sanguineti G, Spriano G. Prevention of fistulas after salvage laryngectomy using temporoparietal fascia free flap. ACTA ACUST UNITED AC 2021; 40:181-189. [PMID: 32773779 PMCID: PMC7416370 DOI: 10.14639/0392-100x-n0411] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/08/2019] [Indexed: 12/03/2022]
Abstract
We conducted a retrospective review to assess the role of the temporoparietalis fascia flap (TPFF), comparing rates of postoperative pharyngocutaneous fistula (PCF) and functional outcomes with those of pectoralis major myocutaneous flap (PMMF) and primary closure of the pharynx, in a population of patients treated with salvage total laryngectomy (STL). Patients were divided in three groups depending on the pharynx reconstruction technique after primary closure: no vascularised tissue augmentation (group 1), PMMF patch (group 2), or TPFF patch (group 3). The main outcomes analysed were overall fistula rate, fistula requiring reoperation and speech and swallowing function at 6 months. Factors influencing the incidence of fistulas were also evaluated. 39 patients respected inclusion criteria: 14, 11 and 14 patients in the three groups, respectively. Nine patients of 39 (23.1%) experienced a PCF. No statistically significant differences were noted between the three groups, except for a longer surgical operation time and a trend for better functional results in group 3. None of the factors analysed significantly influenced the overall rate of fistula. TPFF patch thus represents a reliable alternative to PMMF in preventing PCF in the setting of STL, with minor donor-site morbidity and good functional outcomes.
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Affiliation(s)
- Raul Pellini
- IRCCS "Regina Elena" National Cancer Center, Rome, Italy
| | - Jacopo Zocchi
- IRCCS "Regina Elena" National Cancer Center, Rome, Italy
| | - Barbara Pichi
- IRCCS "Regina Elena" National Cancer Center, Rome, Italy
| | | | - Paolo Marchesi
- IRCCS "Regina Elena" National Cancer Center, Rome, Italy
| | | | - Giuseppe Mercante
- Otorhinolaryngology Unit, Humanitas University, IRCCS Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - Gabriele Molteni
- Department of Otolaryngology, University Hospital of Verona. University of Verona
| | - Oreste Iocca
- Otorhinolaryngology Unit, Humanitas University, IRCCS Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - Pasquale Di Maio
- Otorhinolaryngology Unit, Humanitas University, IRCCS Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - Armando De Virgilio
- Otorhinolaryngology Unit, Humanitas University, IRCCS Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - Antonello Vidiri
- IRCCS "Regina Elena" National Cancer Center Department of Radiology
| | | | - Giuseppe Spriano
- Otorhinolaryngology Unit, Humanitas University, IRCCS Humanitas Clinical and Research Center, Rozzano (MI), Italy
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11
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Petruzzi G, Zocchi J, Pellini R. Temporoparietal fascia free flap harvesting: A surgical technique video. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138 Suppl 2:49-51. [PMID: 34083173 DOI: 10.1016/j.anorl.2020.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/18/2020] [Accepted: 11/09/2020] [Indexed: 11/25/2022]
Affiliation(s)
- G Petruzzi
- Department of Otolaryngology and Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - J Zocchi
- Department of Otolaryngology and Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - R Pellini
- Department of Otolaryngology and Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
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Molteni G, Gazzini L, Sacchetto A, Nocini R, Marchioni D. Role of the temporoparietal fascia free flap in salvage total laryngectomy. Head Neck 2021; 43:1692-1694. [PMID: 33433928 DOI: 10.1002/hed.26602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/16/2020] [Accepted: 12/29/2020] [Indexed: 11/06/2022] Open
Abstract
The procedure for salvage total laryngectomy (STL) is burdened by a high rate of postoperative complications as a result of delayed wound healing in previously irradiated tissue. Several observational studies have investigated the role of prophylactic vascularized flaps to aid pharyngeal closure after STL and prevent the development of PCF. The use of a temporoparietal fascia free flap (TFFF) as an overlay flap for STL has been described previously in two published studies and both sets of authors agreed that the most obvious benefit of the TFFF in STL is a reduced PCF rate with low site morbidity and good functional outcomes. The aim of this video is to illustrate the use of the temporoparietal fascia flap to provide an adjunctive reinforcement layer in the reconstruction of the pharynx.
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Affiliation(s)
- Gabriele Molteni
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Verona, Verona, Italy
| | - Luca Gazzini
- Division of Otorhinolaryngology-Head and Neck Surgery, "San Maurizio" Hospital, Bolzano, Italy
| | - Andrea Sacchetto
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Verona, Verona, Italy
| | - Riccardo Nocini
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Verona, Verona, Italy
| | - Daniele Marchioni
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Verona, Verona, Italy
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Platelet-rich fibrin: an autologous biomaterial for healing assistance of pharyngeal repair in total laryngectomy. Eur Arch Otorhinolaryngol 2020; 278:463-470. [PMID: 33009930 DOI: 10.1007/s00405-020-06404-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/24/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the potential role of platelet-rich fibrin (PRF) application on the pharyngeal repair on decreasing the incidence of pharyngocutaneous fistula (PCF) after total laryngectomy. METHODS This randomized controlled clinical trial was conducted on 67 patients with advanced laryngeal carcinoma who underwent total laryngectomy, over 2 years in the Otorhinolaryngology Department, Mansoura University Hospitals, Egypt. Patients were randomly assigned into two groups: PRF group (n = 35) and control group (n = 32). Risk factors for development of PCF as well as the incidence of PCF were studied in both groups. RESULTS There was no statistically significant difference between groups regarding demographic data, medical comorbidities, basal hemoglobin and albumin levels, data related to the tumor (location, grade and TNM staging) and surgical details (preoperative tracheotomy and neck dissection). However, regarding the incidence of PCF, there was a statistically significant difference between groups as shown in Table 2. PCF was detected in 2/35 patients (5.7%) in the PRF group and in 10/32 patients (31.3%) in the control group (p = 0.004). CONCLUSION PRF application on the pharyngeal repair after total laryngectomy enhances the healing process and consequently decreases the incidence of PCF.
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Ravina K, Rennert RC, Strickland BA, Chien M, Carey JN, Russin JJ. Pedicled temporoparietal fascial flap for combined revascularization in adult moyamoya disease. J Neurosurg 2019; 131:1501-1507. [PMID: 30497163 DOI: 10.3171/2018.5.jns18938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 05/29/2018] [Indexed: 11/06/2022]
Abstract
Moyamoya disease (MMD) is a progressive, idiopathic cerebrovascular occlusive disease. Various revascularization techniques including direct, indirect, and combined microvascular bypasses have been described. This article presents a modified revascularization technique for MMD utilizing a pedicled temporoparietal fascial flap (TPFF) for combined revascularization. This technique combines a large area of coverage for indirect revascularization with the benefits of a direct bypass. The pedicled TPFF also benefits from intact venous drainage to minimize the risk of flap swelling that could result in complications from mass effect.
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Affiliation(s)
| | - Robert C Rennert
- 2Department of Neurosurgery, University of California, San Diego, California
| | | | | | - Joseph N Carey
- 4Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles; and
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Huang ZQ, Zhou B, Chen WL, Zhong JL, Wang Y. Use of a folded extended vertical lower trapezius island myocutaneous flap to repair large pharyngocutaneous fistulae developing after salvage total laryngectomy. Int J Oral Maxillofac Surg 2018; 47:1268-1273. [DOI: 10.1016/j.ijom.2018.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/20/2018] [Accepted: 05/22/2018] [Indexed: 10/14/2022]
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16
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Epprecht L, Schlegel C, Holzmann D, Soyka M, Kaufmann T. Closure of nasal septal perforations with a polydioxanone plate and temporoparietal fascia in a closed approach. Am J Rhinol Allergy 2018; 31:190-195. [PMID: 28490406 DOI: 10.2500/ajra.2017.31.4431] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Septal perforation closure is still often invasive and complex, with relatively low closure rates. OBJECTIVES We aimed to provide the first results of a case series of 20 patients with nasal septal perforations who underwent septal perforation repair by both an open and a minimally invasive technique by using a graft that consisted of temporoparietal fascia and a polydioxanone (PDS) plate without mucosal flaps. Between 2014 and 2016, we tested, for the first time, the feasibility of the insertion of this graft via a hemitransfixion incision at our institution. The rationale for the closed approach was to avoid any visible nasal scars. We reported our results of both approaches. METHODS The septal perforations were closed by insertion of a graft, which consisted of a 0.25-mm PDS flexible plate enveloped by temporoparietal fascia, into the perforation. The insertion of the graft was performed either via a columellar incision (open approach) or via a cosmetically advantageous hemitransfixion incision (closed approach) in an underlay technique. No attempts were made to close the perforation by mucosal flap rotation and/or advancement. Protective silastic sheeting to both sides of the perforation provided fixation to the graft while natural mucosal healing occurred over the perforation in the course of 3 to 8 weeks. RESULTS Eighteen of 20 perforations were closed by mucosa at the last follow-up. The mean follow-up was 8.7 months. Thirteen patients had surgery via the closed approach. CONCLUSION We showed, for the first time, that the insertion of a graft that consisted of a PDS flexible plate enveloped in temporoparietal fascia via a hemitransfixion incision was feasible and resulted in complete mucosal closure of nasal septal perforations in most patients. By performing the hemitransfixion incision, we avoided any visible nasal scars.
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Chiesa Estomba CM, González García JA, Sistiaga Suarez JA, Arrizabalaga IT, Larruscain Sarasola E, Altuna Mariezcurrena X. Efficacy of the Myofascial Pectoralis Major Flap in the Reduction of Salivary Fistulas After Salvage Total Laryngectomy. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018. [DOI: 10.1016/j.otoeng.2017.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Chiesa Estomba CM, González García JA, Sistiaga Suarez JA, Thomas Arrizabalaga I, Larruscain Sarasola E, Altuna Mariezcurrena X. Efectividad del colgajo de músculo pectoral mayor miofascial en la reducción de fístulas salivares tras laringectomía total de rescate. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018; 69:99-104. [DOI: 10.1016/j.otorri.2017.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/26/2017] [Accepted: 06/01/2017] [Indexed: 12/01/2022]
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19
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Reconstruction after salvage laryngectomy. Oral Oncol 2017; 75:22-27. [DOI: 10.1016/j.oraloncology.2017.10.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/23/2017] [Accepted: 10/11/2017] [Indexed: 12/28/2022]
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Brady JS, Crippen MM, Filimonov A, Eloy JA, Baredes S, Park RCW. Laryngectomy and smoking: An analysis of postoperative risk. Laryngoscope 2017; 127:2302-2309. [PMID: 28671270 DOI: 10.1002/lary.26615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/02/2017] [Accepted: 03/10/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To investigate the impact of smoking on complication rates following total laryngectomy. STUDY DESIGN AND METHODS The National Surgical Quality Improvement Program database was queried for all total laryngectomies between 2005 and 2014. Patients were identified as smokers (n = 561) or nonsmokers (n = 513) and compared via univariate and multivariate analyses. A nearest-neighbor propensity score-generating algorithm was used to build a subpopulation (n = 714) of matched cases and evaluated in a similar manner. Additionally, pack-year data was available for select cases and analyzed appropriately. RESULTS On multivariate analysis of the unmatched cohort accounting for demographics and confounders, no significant difference in overall medical complications was identified between groups (odds ratio = 0.799, P = 0.495). Propensity matching corrected for all significantly distributed comorbidities, except for alcohol, which remained associated with the smoking group (P = < 0.001). In the matched population, there were no significant differences in complication rates between the two groups. Pack-year data was available for 340 patients. These cases were subdivided into cohorts with < 50 (n = 204) and 51+ (n = 136) pack-years. Postoperative pneumonia, ventilation for more than 48 hours, sepsis, and overall medical complications were associated with > 50 pack-years of smoking. After multivariate regression, sepsis and overall medical complications remained significant for the 51+ pack-year smoking cohort. CONCLUSION After accounting for confounding comorbidities, smoking is found to play an insignificant role in the development of postoperative complications following total laryngectomy. However, those with 51+ pack-years are at an increased risk for postoperative sepsis and overall medical complications following these complex procedures. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2302-2309, 2017.
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Affiliation(s)
- Jacob S Brady
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Meghan M Crippen
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Andrey Filimonov
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Richard Chan Woo Park
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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Abstract
Answer questions and earn CME/CNE Laryngeal cancer remains one of the most common tumors of the respiratory tract. Fortunately, significant advancements have been made over the past decade in the treatment of laryngeal cancer. Although surgery has been the historical mainstay for localized disease and still is an integral part of treatment, nonsurgical options like radiation and systemic therapy have emerged as viable options. In addition, in the metastatic setting, novel agents are showing promise for this patient population. The care for patients with laryngeal cancer continues to evolve and truly requires a multidisciplinary team-based approach. Unique morbidities, such as loss of natural voice, respiration, and airway protection during swallowing, are observed with this disease and require special consideration. CA Cancer J Clin 2017;67:31-50. © 2016 American Cancer Society.
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Affiliation(s)
- Conor E Steuer
- Assistant Professor, Department of Hematology Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Mark El-Deiry
- Associate Professor, Department of Otolaryngology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Jason R Parks
- Resident, Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Kristin A Higgins
- Assistant Professor, Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Nabil F Saba
- Professor and Director of the Head and Neck Medical Oncology Program, Department of Hematology Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
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22
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Systematic review and meta-analysis of the complications of salvage total laryngectomy. Eur J Surg Oncol 2017; 43:42-51. [DOI: 10.1016/j.ejso.2016.05.017] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 05/14/2016] [Indexed: 11/22/2022] Open
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Role of the pectoralis major myofascial flap in preventing pharyngocutaneous fistula following salvage laryngectomy. The Journal of Laryngology & Otology 2016; 130:860-4. [DOI: 10.1017/s0022215116008501] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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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Merdad M, Higgins K, Enepikedis D. In reference to Vascularized tissue to reduce fistula following salvage total laryngectomy: a systematic review. Laryngoscope 2014; 125:E157. [PMID: 25431179 DOI: 10.1002/lary.25039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 09/10/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Mazin Merdad
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
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Paleri V, Drinnan M, van den Brekel MWM, Takes RP, Rinaldo A, Ferlito A. In response to Vascularized tissue to reduce fistula following salvage total laryngectomy: a systematic review. Laryngoscope 2014; 125:E156. [PMID: 25388094 DOI: 10.1002/lary.25018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Vinidh Paleri
- Department of Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Foundation Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom
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Sayles M, Grant DG. Preventing pharyngo-cutaneous fistula in total laryngectomy: A systematic review and meta-analysis. Laryngoscope 2013; 124:1150-63. [DOI: 10.1002/lary.24448] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 09/02/2013] [Accepted: 09/23/2013] [Indexed: 12/29/2022]
Affiliation(s)
- Mark Sayles
- Department of Otolaryngology-Head and Neck Surgery; Queen's Medical Centre; Nottingham University Hospitals' NHS Trust; Nottingham United Kingdom
| | - David G. Grant
- Department of Otolaryngology-Head and Neck Surgery; Queen's Medical Centre; Nottingham University Hospitals' NHS Trust; Nottingham United Kingdom
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Kim K, Ibrahim AMS, Koolen PGL, Frankenthaler RA, Lin SJ. Analysis of the NSQIP Database in 676 Patients Undergoing Laryngopharyngectomy. Otolaryngol Head Neck Surg 2013; 150:87-94. [DOI: 10.1177/0194599813511785] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Assess impact of reconstructive procedures on patients undergoing laryngopharyngectomy and to determine whether 30-day postoperative morbidity and mortality varied between patients who underwent flap reconstruction and those who did not. Study Design Retrospective analysis of the prospectively collected American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database. Setting Tertiary medical center. Subjects and Methods We reviewed the 2005-2011 ACS-NSQIP database to identify patients undergoing laryngectomy and/or pharyngectomy. Bivariate analysis was done to compare preoperative variables and postoperative outcomes between the flap reconstruction group and non-reconstruction group. Chi-square tests were used for categorical variables and t-tests for continuous variables. Logistic regression analysis was performed to calculate odds ratio to account for potential confounders. To create a valid logistic analysis model, F-test was used to determine whether certain variables should be included in the model. Results Six hundred seventy-six patients were included in our study; 213 patients received concurrent flap reconstruction whereas 463 did not. After risk adjustment, analyses revealed no statistically significant difference in wound complication, minor morbidity, and mortality between the 2 groups. The flap reconstruction cohort showed significantly longer operative times (8.09 ± 3.36 hours vs 5.63 ± 3.47 hours; P = .001) and higher major morbidity rate (OR = 5.906, 95% CI, 3.131-11.139, P = .001). Conclusions This is the first comprehensive analysis of flap reconstruction for laryngopharyngeal defects using the ACS-NSQIP registry. Additional measures involved in flap reconstruction are associated with an increase in major morbidity but not mortality. An understanding of these variables may optimize the decision-making process for patients undergoing laryngectomy and/or pharyngectomy.
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Affiliation(s)
- Kuylhee Kim
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ahmed M. S. Ibrahim
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Pieter G. L. Koolen
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert A. Frankenthaler
- Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel J. Lin
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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