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Sanchez A, Frank E, Inman J, Wang W, Namin A, Ducic Y. Fistula Management in Head and Neck Cancer. Semin Plast Surg 2020; 34:299-304. [PMID: 33380917 PMCID: PMC7759424 DOI: 10.1055/s-0040-1721825] [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] [Indexed: 12/13/2022]
Abstract
Fistulas in head and neck cancer patients are a common and challenging issue. Despite their commonality, there is little consensus regarding optimal treatment strategies or in preventative measures that might be taken preoperatively. A general knowledge and understanding of what factors correlate with fistula formation can assist a surgeon in optimizing a patient for surgery, thus decreasing prevalence. In addition, surgical techniques can aid in both the prevention and treatment of fistulas once they form. This review details risk factors for fistula formation, the use of vascularized tissue as a preventative measure, conservative and nonconservative treatment of fistulas, and possible strategies to decrease the likelihood of their formation.
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Affiliation(s)
- Anthony Sanchez
- Department of Otolaryngology – Head & Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Ethan Frank
- Department of Otolaryngology – Head & Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Jared Inman
- Department of Otolaryngology – Head & Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Weitao Wang
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Arya Namin
- Department of Otolaryngology – Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Lin YH, Ou CY, Lee WT, Lee YC, Chang TY, Yen YT. Treatment outcomes for one-stage concurrent surgical resection and reconstruction of synchronous esophageal and head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol 2019; 276:2929-2940. [PMID: 31332550 DOI: 10.1007/s00405-019-05564-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/13/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE It is not uncommon to see the synchronous presentation of esophageal squamous carcinoma (ESCC) and head and neck cancer (HNC), and most patients were treated with staged interventions. This study retrospectively reported the outcomes of patients with synchronous ESCC and HNC treated with one-stage concurrent surgical resection and reconstruction. METHODS We identified 17 consecutive patients with synchronous ESCC and HNC undergoing primary concurrent surgical resections between 2011 and 2017 at our hospital. All patients had received esophageal screenings prior to treatment. RESULTS The HNC patients in this study had the following subsite involvements: oral cavity (n = 5), oropharynx (n = 4), larynx (n = 1), hypopharynx (n = 9), and thyroid gland (n = 1). Eighty percent of the HNC subsites (16/20) were treated in advanced stages, while most ESCCs were treated at early stages. The mean follow-up time was 3.2 ± 1.6 years. Surgery-associated morbidity and mortality were 94.1% and 0%, respectively, and the most common complication was anastomotic leakage. The two-year overall survival, 2-year loco-regional recurrence-free survival, and 2-year distant metastasis-free survival were 86.7%, 85.6%, and 78.7%, respectively. No significant difference was found between overall survival and HNC subsite or anastomotic leakage. Four patients (23.5%) developed secondary primary malignancies (SPMs) within a mean follow-up period of 2.9 years (standard deviation 1.6 years). CONCLUSION Although one-stage concurrent surgical resection and reconstruction of synchronous ESCC and HNC were highly invasive and complicated, survival was promising. Isolated distant metastasis remained the most common failure pattern. Vigilant follow-up strategy is mandatory to detect secondary primary malignancies (SPMs), especially within the first 3 years following initial treatment.
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Affiliation(s)
- Yu-Hsuan Lin
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Otolaryngology, Head and Neck Surgery, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Yen Ou
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ting Lee
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yao -Chou Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tzu -Yen Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital Dou-Liou Branch, College of Medicine, Tainan, Taiwan
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. .,Division of Trauma and Acute Care Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan.
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3
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Salvage laryngectomy and laryngopharyngectomy: Multicenter review of outcomes associated with a reconstructive approach. Head Neck 2018; 41:16-29. [DOI: 10.1002/hed.25192] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 01/03/2018] [Accepted: 03/02/2018] [Indexed: 11/08/2022] Open
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Vidhyadharan S, Thankappan K, Janarthanan R, Balasubramanian D, Sharma M, Mathew J, Sudheer OV, Iyer S. Gastro-omental free flap for reconstruction of tongue defects. Oral Oncol 2018; 83:134-139. [PMID: 30098769 DOI: 10.1016/j.oraloncology.2018.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 05/26/2018] [Accepted: 06/18/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The purpose of this paper is to report the technique and outcomes of the use of gastro-omental free flap reconstruction in glossectomy defects. MATERIALS AND METHODS This is a prospective case series of 9 patients of tongue squamous cell carcinoma, who underwent either subtotal or partial glossectomy and reconstruction with gastro-omental free flap. The flap anatomy, surgical technique and the outcomes including the swallowing and speech are presented. RESULTS Five patients underwent partial glossectomy and 4 had sub-total glossectomy. The median age was 43 years; and the median follow up was 11.4 months. Laparoscopic harvest was done in 8 patients. There was one flap loss. Seven patients underwent postoperative radiotherapy. Functional evaluation was done in 5 patients who were disease free. Four could tolerate soft diet orally, one patient was on liquid to pureed diet. Speech was intelligible in 4. None of the patients had any complications related to laparotomy or laparoscopy. CONCLUSION Gastro-omental flap provided a secretory mucosal surface and was beneficial in the saliva depleted patients post radiotherapy. The laparoscopic harvest of this flap has minimized donor site morbidity. One patient had a flap loss. Two patients reported superficial ulcerations on the surface, one of them had to undergo surgical debulking to correct it while the other healed with conservative measures. Speech and swallowing outcomes of the reconstructed tongue was good, especially in patients with partial glossectomy. The reconstructed gastric mucosal flaps tolerated the adjuvant radiation well.
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Affiliation(s)
- Sivakumar Vidhyadharan
- Department of Head & Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham Kochi, Kerala, India
| | - Krishnakumar Thankappan
- Department of Head & Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham Kochi, Kerala, India.
| | - Ramu Janarthanan
- Department of Plastic & Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita Viswha Vidyapeetham Kochi, Kerala, India
| | - Deepak Balasubramanian
- Department of Head & Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham Kochi, Kerala, India
| | - Mohit Sharma
- Department of Plastic & Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita Viswha Vidyapeetham Kochi, Kerala, India
| | - Jimmy Mathew
- Department of Plastic & Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita Viswha Vidyapeetham Kochi, Kerala, India
| | - Othiyil Vayoth Sudheer
- Department of Gastro - Intestinal Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham Kochi, Kerala, India
| | - Subramania Iyer
- Department of Head & Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham Kochi, Kerala, India
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Microsurgical reconstruction of pharyngoesophageal defects—case series and critical review of the literature. EUROPEAN JOURNAL OF PLASTIC SURGERY 2018. [DOI: 10.1007/s00238-017-1335-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rosenthal E, Couch M, Farwell DG, Wax MK. Current concepts in microvascular reconstruction. Otolaryngol Head Neck Surg 2016; 136:519-24. [PMID: 17418245 DOI: 10.1016/j.otohns.2006.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Accepted: 12/05/2006] [Indexed: 10/23/2022]
Affiliation(s)
- Eben Rosenthal
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, USA
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Ki SH, Choi JH, Sim SH. Reconstructive Trends in Post-Ablation Patients with Esophagus and Hypopharynx Defect. Arch Craniofac Surg 2015; 16:105-113. [PMID: 28913234 PMCID: PMC5556778 DOI: 10.7181/acfs.2015.16.3.105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 12/18/2022] Open
Abstract
The main challenge in pharyngoesophageal reconstruction is the restoration of swallow and speech functions. The aim of this paper is to review the reconstructive options and associated complications for patients with head and neck cancer. A literature review was performed for pharynoesophagus reconstruction after ablative surgery of head and neck cancer for studies published between January 1980 to July 2015 and listed in the PubMed database. Search queries were made using a combination of 'esophagus' and 'free flap', 'microsurgical', or 'free tissue transfer'. The search query resulted in 123 studies, of which 33 studies were full text publications that met inclusion criteria. Further review into the reference of these 33 studies resulted in 15 additional studies to be included. The pharyngoesophagus reconstruction should be individualized for each patient and clinical context. Fasciocutaneous free flap and pedicled flap are effective for partial phayngoesophageal defect. Fasciocutaneous free flap and jejunal free flap are effective for circumferential defect. Pedicled flaps remain a safe option in the context of high surgical risk patients, presence of fistula. Among free flaps, anterolateral thigh free flap and jejunal free flap were associated with superior outcomes, when compared with radial forearm free flap. Speech function is reported to be better for the fasciocutaneous free flap than for the jejunal free flap.
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Affiliation(s)
- Sae Hwi Ki
- Department of Plastic Surgery, Inha University School of Medicine, Incheon, Korea.,Department of Plastic Surgery, Inha University Hospital, Incheon, Korea
| | - Jong Hwan Choi
- Department of Plastic Surgery, Inha University Hospital, Incheon, Korea
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Goessler UR. Traditional transcutaneous approaches in head and neck surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 11:Doc06. [PMID: 23320058 PMCID: PMC3544212 DOI: 10.3205/cto000088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The treatment of laryngeal and hypopharyngeal malignancies remains a challenging task for the head and neck surgeon as the chosen treatment modality often has to bridge the gap between oncologically sound radicality and preservation of function. Due to the increase in transoral laser surgery in early tumor stages and chemoradiation in advanced stages, the usage of traditional transcutaneous approaches has decreased over the recent past. In addition, the need for a function-sparing surgical approach as well as highest possible quality of life has become evident. In view of these facts, rationale and importance of traditional transcutaneous approaches to the treatment of laryngeal and hypopharyngeal malignancies are discussed in a contemporary background. The transcutaneous open partial laryngectomies remain a valuable tool in the surgeon's armamentarium for the treatment of early and advanced laryngeal carcinomas, especially in cases of impossible laryngeal overview using the rigid laryngoscope. Open partial laryngetomies offer superior overview and oncologic safety at the anterior commissure, especially in recurrencies. In select advanced cases and salvage settings, the supracricoid laryngectomy offers a valuable tool for function-preserving but oncologically safe surgical therapy at the cost of high postoperative morbidity and a very demanding rehabilitation of swallowing.In hypopharyngeal malignancies, the increasing use of transoral laser surgery has led to a decline in transcutaneous resections via partial pharyngectomy with partial laryngectomy in early tumor stages. In advanced stages of tumors of the piriform sinus and the postcricoid area with involvement of the larynx, total laryngectomy with partial pharyngectomy is an oncologically safe approach. The radical surgical approach using circumferent laryngopharyngectomy with/without esophagectomy is indicated in salvage cases with advanced recurrences or as a primary surgical approach in patients where chemoradiation does not offer sufficient oncologic control or preservation of function. In cases with impending reconstruction, fasciocutaneous free flaps (anterolateral thigh flap, radial forearm flap) seem to offer superior results to enteric flaps in cases where the cervical esophagus is not involved leading to better voice rehabilitation with fewer complications and postoperative morbidity. In salvage situations, the Gastroomental Free Flap has proven to be a valuable tool.In conclusion, the choice of a surgical treatment modality is influenced by the patient's anatomy, tumor size and location as well as the surgeon's personal expertise.
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Kothari KC, Bhargavan RV, Patel M, Batra T. Laparoscopic gastric mobilization in postcricoid cancer surgery. J Laparoendosc Adv Surg Tech A 2012; 22:819-23. [PMID: 23039705 DOI: 10.1089/lap.2011.0379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIM Postcricoid cancer is an aggressive neoplasm that presents specific therapeutic problems. This study compares laparoscopic stomach mobilization following total pharyngolaryngoesophagectomy (TPLE) with open mobilization following TPLE with respect to postoperative recovery, perioperative morbidity, and mortality. SUBJECTS AND METHODS This is a retrospective study in a contemporary series of patients with resectable postcricoid cancer from a single institute (Gujarat Cancer & Research Institute, M.P. Shah Cancer Hospital, Ahmedabad, Gujarat, India). Twenty-five consecutive patients who underwent laparoscopic TPLE were compared with 40 patients who underwent open TPLE from January 2006 to December 2010. RESULTS Laparoscopic and open TPLE procedures were compared with respect to patient demographics, operative information (blood loss, duration), and complications. The mean duration of surgery was 3.5 hours in the laparoscopic group and 5.5 hours in the open group. The respective mean blood loss was 290 mL and 460 mL. The respective mean time to full oral intake was 10 days and 11 days. The respective average duration of hospitalization was 13 days and 17 days. In the laparoscopic group, 3 (12%) and 4 (16%) patients had pneumonic consolidation and wound infection, respectively, compared with 8 (20%) and 8 (20%) patients in the open group. In the laparoscopic group, there were two (8%) perioperative deaths, compared with four (10%) in the open group. CONCLUSIONS Laparoscopic TPLE is safe with less morbidity and mortality and quicker postoperative recovery compared with open surgery.
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Affiliation(s)
- Kiran C Kothari
- Department of Laparoscopy, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
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Reconstructive options after total laryngectomy with subtotal or circumferential hypopharyngectomy and cervical esophagectomy. Curr Opin Otolaryngol Head Neck Surg 2012; 20:77-88. [PMID: 22327791 DOI: 10.1097/moo.0b013e328350a5cc] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW The present review is focused on the main reconstructive options currently used after partial or circumferential resection of the hypopharynx and cervical esophagus. The advantages and disadvantages of pectoralis major myocutaneous (PMMC) pedicled flap, fasciocutaneous free flaps as radial forearm and anterolateral thigh (ALT), and visceral free grafts like jejunum and gastro-omental are overviewed. RECENT FINDINGS For partial hypopharyngeal defects with limited extension to the cervical esophagus, no specific pedicled or free flap is deemed superior over others: the patient's body habitus and surgeon's preference remain the most important factors affecting the reconstructive choice. In contrast, after circumferential hypopharyngectomy, pharyngocutaneous fistula (PCF) and stricture rates of PMMC are higher than those obtained by free flaps. In the most recent series applying ALT and jejunum, PCF and stricture occurrence is comparable, whereas reduced mortality, overall complication rate, and donor-site morbidity of ALT and its better swallowing and speech outcomes have contributed to make this option progressively more popular. On the other hand, gastro-omental seems to offer an unparalleled amount of highly vascularized tissue to manage the difficult situation of salvage surgery after chemoradiation, even though complication rates remain not negligible and this technique has not been widely adopted. SUMMARY The reconstructive armamentarium of head and neck surgeons involved in hypopharyngeal and cervical esophagus reconstruction should encompass every option described herein in order to appropriately deal with specific clinical needs and patient requirements. However, fasciocutaneous free flaps (especially ALT) seem to play an ever greater role in restoration of pharyngoesophageal continuity.
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Ochala C, Grosdidier A, Righini C, Lebeau J, Bettega G. Free anterolateral thigh flap for reconstruction of upper aerodigestive tract defects. Eur Ann Otorhinolaryngol Head Neck Dis 2011; 128:331-4. [PMID: 22118783 DOI: 10.1016/j.anorl.2011.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 05/19/2011] [Accepted: 05/20/2011] [Indexed: 11/28/2022]
Affiliation(s)
- C Ochala
- Service de chirurgie maxillo-faciale et plastique, hôpital Michallon, CHU Grenoble, boulevard Chantourne, 38700 La Tronche, France.
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Gastro-omental free flap in the reconstruction of the unfavourable hypopharyngeal defects: A functional assessment. J Plast Reconstr Aesthet Surg 2009; 62:1367-73. [DOI: 10.1016/j.bjps.2008.05.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2008] [Accepted: 05/29/2008] [Indexed: 11/19/2022]
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Patel RS, Gilbert RW. Utility of the gastro-omental free flap in head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2009; 17:258-62. [PMID: 19444111 DOI: 10.1097/moo.0b013e32832cba42] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW In the current era of organ-preservation therapies, surgical salvage and reconstruction of defects following ablation of mucosa and soft tissue in the head and neck is extremely challenging because of the toxic effects of chemoradiation and intensive radiotherapy on wounds. The anatomical, physiological and immunological properties of the gastro-omental flap make it an ideal reconstructive technique in head and neck surgery. RECENT FINDINGS Several case series published in the past 12 months highlight the utility of this flap in inhospitable wounds and particularly in restoration of circumferential pharyngeal defects. The gastro-omental flap produces satisfactory functional results and morbidity in this group of high-risk patients. SUMMARY The gastro-omental free flap provides an alternative to traditional reconstructive techniques that is ideally suited to high-risk complex wounds in the head and neck.
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Affiliation(s)
- Rajan S Patel
- Department of Otolaryngology-Head and Neck Surgery, Auckland City Hospital, University of Auckland, New Zealand.
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Alcalde JM, Gimeno-Vilar C, Montes-Jovellar L, Manrique R, Sanhueza I. Reconstrucción de defectos faríngeos. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2009; 60:283-90. [DOI: 10.1016/j.otorri.2009.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Accepted: 03/05/2009] [Indexed: 11/30/2022]
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Patel RS, Makitie AA, Goldstein DP, Gullane PJ, Brown D, Irish J, Gilbert RW. Morbidity and functional outcomes following gastro-omental free flap reconstruction of circumferential pharyngeal defects. Head Neck 2009; 31:655-63. [DOI: 10.1002/hed.21016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Dassonville O, Poissonnet G, Santini J, Bozec A. Réparation par lambeaux libres en cancérologie des voies aérodigestives supérieures. ONCOLOGIE 2009. [DOI: 10.1007/s10269-008-1030-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Alcalde JM, Gimeno-Vilar C, Montes-Jovellar L, Manrique R, Sanhueza I. Reconstruction of pharyngeal defects. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2009. [DOI: 10.1016/s2173-5735(09)70144-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Murray DJ, Novak CB, Neligan PC. Fasciocutaneous free flaps in pharyngolaryngo-oesophageal reconstruction: a critical review of the literature. J Plast Reconstr Aesthet Surg 2008; 61:1148-56. [DOI: 10.1016/j.bjps.2007.09.030] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Revised: 01/17/2007] [Accepted: 09/24/2007] [Indexed: 11/29/2022]
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Dassonville O, Poissonnet G, Chamorey E, Vallicioni J, Demard F, Santini J, Lecoq M, Converset S, Mahdyoun P, Bozec A. Head and neck reconstruction with free flaps: a report on 213 cases. Eur Arch Otorhinolaryngol 2007; 265:85-95. [PMID: 17690895 DOI: 10.1007/s00405-007-0410-1] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Accepted: 07/17/2007] [Indexed: 10/23/2022]
Abstract
The aim of this retrospective study is to review the experience of our institution in performing microvascular head and neck reconstruction between 2000 and 2004. During this period, 213 free flaps, including 146 radial forearm free flaps, 60 fibular flaps and 7 scapular flaps, were performed. Free flap success rate and complications were reported. The pre-treatment factors influencing these results were subsequently analyzed. Functional and aesthetic outcomes were evaluated by the same clinician. There were 14 free flap failures, giving an overall free flap success rate of 93.4%. Salvage surgery for recurrent cancer was the only factor correlated with a higher risk of free flap failure (P = 0.0004). The local complication rate was 20.9%. High level of comorbidity (P = 0.009), salvage surgery for recurrent cancer (P = 0.03) and hypopharyngeal surgery (P = 0.002) were associated with a higher risk of local complications. An unrestricted oral diet and an intelligible speech were recovered by respectively 76 and 88% of the patients. Microvascular free flaps represent an essential and reliable technique for head neck reconstruction and allow satisfactory functional results.
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Affiliation(s)
- Olivier Dassonville
- Département d'Oto-Rhino-Laryngologie et de chirurgie de la Face et du Cou, Centre Antoine Lacassagne, 33 Avenue de Valombrose, 06189, Nice Cedex, France.
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Murray DJ, Gilbert RW, Vesely MJJ, Novak CB, Zaitlin-Gencher S, Clark JR, Gullane PJ, Neligan PC. Functional outcomes and donor site morbidity following circumferential pharyngoesophageal reconstruction using an anterolateral thigh flap and salivary bypass tube. Head Neck 2007; 29:147-54. [PMID: 17022086 DOI: 10.1002/hed.20489] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study reports our experience with fasciocutaneous reconstruction of circumferential pharyngoesophageal defects using an anterolateral thigh flap wrapped around a salivary bypass tube. METHODS The charts of 14 patients were reviewed. All patients who had reconstruction of a pharyngoesophageal defect using an anterolateral thigh flap with a salivary bypass tube between 2001 and 2005 were included. RESULTS There were 10 men and 4 women (mean age, 61 years). There were no fistulae reported, and the stricture rate was 14%. Eleven patients achieved oral diet sufficient to have the gastrostomy or jejunal tube removed. The patients who had tracheoesophageal puncture for voice developed functional speech. There were no flap losses. However, problems with salivary tube migration in the early cases have led to technique refinement. CONCLUSIONS The low complication rates and the excellent functional outcomes make the anterolateral thigh flap in combination with a salivary bypass tube a viable option for reconstruction of these difficult defects.
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Affiliation(s)
- Dylan J Murray
- Division of Plastic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Bibliography. Current world literature. Head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2006; 14:289-91. [PMID: 16832188 DOI: 10.1097/01.moo.0000233602.37541.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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