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Zhou J, Zuo E, Ding Y, Wu J, Jin Y, Chen X. Effect of Preoperative Neck Radiotherapy on the Reconstruction of Head and Neck Defects With the Supraclavicular Artery Island Flap. EAR, NOSE & THROAT JOURNAL 2024:1455613241253713. [PMID: 38742667 DOI: 10.1177/01455613241253713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
Purpose: The supraclavicular artery island (SAI) flap is commonly used in the reconstruction of head and neck defects. However, the safety of SAI flaps for neck irradiated patient needs to be verified. To investigate the safety of using the SAI flap for patients who have undergone neck radiotherapy, as well as the risk factors for flap complications. Materials and Methods: Sixty-one patients (16 irradiated and 45 nonirradiated) with SAI flap-reconstructed head and neck defects were included, and relevant data were collected retrospectively. The gender, age, body mass index, presence of diabetes mellitus, preoperative albumin level, and flap size between irradiated and nonirradiated patients had no significant difference. Results: No significant difference was observed in the incidence of complications (total, mild, or severe) between the radiotherapy and nonradiotherapy groups. In univariate analysis, preoperative radiotherapy was not associated with postoperative complications of the SAI flap procedure (P = 1.00), while a low preoperative albumin level was a significant risk factor for postoperative complications (P < .05). Conclusions: Our data suggest that preoperative radiotherapy does not increase the risk of SAI flap postoperative complications compared with surgical reconstruction alone.
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Affiliation(s)
- Jing Zhou
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Erdong Zuo
- Department of Otolaryngology Head and Neck Surgery, Mentougou Hospital, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yiming Ding
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jun Wu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yonggang Jin
- Department of Otolaryngology Head and Neck Surgery, People's Hospital of Xianghe County, Xianghe, Hebei Province, China
| | - Xiaohong Chen
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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van Beers MA, Speksnijder CM, van Gils CH, Frederix GWJ, Dankbaar JW, de Bree R. Prophylactic pectoralis major flap to compensate for increased risk of pharyngocutaneous fistula in laryngectomy patients with low skeletal muscle mass (PECTORALIS): study protocol for a randomized controlled trial. BMC Cancer 2024; 24:76. [PMID: 38225572 PMCID: PMC10788993 DOI: 10.1186/s12885-023-11773-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Total laryngectomy (TL) is a surgical procedure commonly performed on patients with advanced laryngeal or hypopharyngeal carcinoma. One of the most common postoperative complications following TL is the development of a pharyngocutaneous fistula (PCF), characterized by a communication between the neopharynx and the skin. PCF can lead to extended hospital stays, delayed oral feeding, and compromised quality of life. The use of a myofascial pectoralis major flap (PMMF) as an onlay technique during pharyngeal closure has shown potential in reducing PCF rates in high risk patients for development of PCF such as patients undergoing TL after chemoradiation and low skeletal muscle mass (SMM). Its impact on various functional outcomes, such as shoulder and neck function, swallowing function, and voice quality, remains less explored. This study aims to investigate the effectiveness of PMMF in reducing PCF rates in patients with low SMM and its potential consequences on patient well-being. METHODS This multicenter study adopts a randomized clinical trial (RCT) design and is funded by the Dutch Cancer Society. Eligible patients for TL, aged ≥ 18 years, mentally competent, and proficient in Dutch, will be enrolled. One hundred and twenty eight patients with low SMM will be centrally randomized to receive TL with or without PMMF, while those without low SMM will undergo standard TL. Primary outcome measurement involves assessing PCF rates within 30 days post-TL. Secondary objectives include evaluating quality of life, shoulder and neck function, swallowing function, and voice quality using standardized questionnaires and functional tests. Data will be collected through electronic patient records. DISCUSSION This study's significance lies in its exploration of the potential benefits of using PMMF as an onlay technique during pharyngeal closure to reduce PCF rates in TL patients with low SMM. By assessing various functional outcomes, the study aims to provide a comprehensive understanding of the impact of PMMF deployment. The anticipated results will contribute valuable insights into optimizing surgical techniques to enhance patient outcomes and inform future treatment strategies for TL patients. TRIAL REGISTRATION NL8605, registered on 11-05-2020; International Clinical Trials Registry Platform (ICTRP).
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Affiliation(s)
- Maartje A van Beers
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Caroline M Speksnijder
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Geert W J Frederix
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands.
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Carnevale C, Morales Olavarría C, Sarría Echegaray P, Til-Pérez G. Single folded supraclavicular artery island flap for simultaneous reconstruction of large composite pharyngeal and external neck skin defect in a radiated patient. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2024; 75:64-66. [PMID: 37343784 DOI: 10.1016/j.otoeng.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/02/2023] [Indexed: 06/23/2023]
Affiliation(s)
- Claudio Carnevale
- Otorhinolaryngology Head and Neck Department, Clínica Rotger, Quirón Salud, Palma de Mallorca, Spain
| | | | - Pedro Sarría Echegaray
- Otorhinolaryngology Head and Neck Department, Clínica Rotger, Quirón Salud, Palma de Mallorca, Spain.
| | - Guillermo Til-Pérez
- Otorhinolaryngology Head and Neck Department, Clínica Rotger, Quirón Salud, Palma de Mallorca, Spain
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Nolte S, Kneser U, Bigdeli AK, Aman M, Struebing F, Tisch M, Gazyakan E. [Interdisciplinary defect reconstruction of upper aerodigestive fistulas-case series and treatment algorithm]. HNO 2023; 71:795-801. [PMID: 37707515 DOI: 10.1007/s00106-023-01358-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Persistent complex defects and dysfunctions of the upper aerodigestive tract after tumor surgery represent a major challenge. The aim of this study was to evaluate the effectiveness of an interdisciplinary approach using the free anterolateral thigh flap (ALT) as a reconstruction option in the upper aerodigestive tract. MATERIALS AND METHODS The retrospective study identified 5 patients with complex defects after laryngectomy/pharyngolaryngectomy (LE/PLE) and multiple revision surgeries between 2017 and 2023. The operations were performed by an interdisciplinary team from otolaryngology, plastic surgery, and visceral/thoracic surgery. The results of the microsurgical reconstruction were analyzed. RESULTS There was an average of six previous operations. The defects included tracheoesophageal fistulas, pharyngocutaneous fistulas, neopharyngeal stenosis, and combinations thereof. Successful reconstruction was achieved in 100% of patients using the ALT flap. In 2 patients, ALT flow-through flaps were used with an additional free jejunal interposition (JI) and in 3 patients split-ALT flaps were used. The major complication rate was 40% and the minor complication rate was 20%. CONCLUSION Complex defects of the upper aerodigestive tract with multiple previous operations can be successfully reconstructed. Because of its versatility, the ALT flap seems to be a very good option. Prerequisite for this is an interdisciplinary treatment approach with a critical assessment of patient- and disease-specific factors.
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Affiliation(s)
- S Nolte
- Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Klinik für Hand und Plastische Chirurgie der Universität Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
- Klinik und Poliklinik für HNO-Heilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - U Kneser
- Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Klinik für Hand und Plastische Chirurgie der Universität Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
| | - A K Bigdeli
- Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Klinik für Hand und Plastische Chirurgie der Universität Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
| | - M Aman
- Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Klinik für Hand und Plastische Chirurgie der Universität Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
| | - F Struebing
- Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Klinik für Hand und Plastische Chirurgie der Universität Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
| | - M Tisch
- Klinik und Poliklinik für HNO-Heilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - E Gazyakan
- Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Klinik für Hand und Plastische Chirurgie der Universität Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland.
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Hu Z, Guo X, Chen L, Lei W. Transnasal negative pressure therapy for accelerating healing and improving the prognosis of pharyngocutaneous fistula. Head Neck 2023; 45:2809-2818. [PMID: 37695059 DOI: 10.1002/hed.27505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/04/2023] [Accepted: 08/23/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Pharyngocutaneous fistula (PCF) is one of the most common complications of total laryngectomy. This study is to investigate the efficacy of a novel platform called transnasal negative pressure therapy (TNPT) in the management of PCF. METHODS We retrospectively reviewed 47 patients who underwent total laryngectomy between April 2015 and February 2021 and developed PCF in our hospital. We focused on the healing rate, dressing change frequency, and healing time between the TNPT and non-TNPT groups. The 2 years overall survival (OS) was compared through the log-rank test. RESULTS There were 18 patients in the TNPT group and 29 in the non-TNPT group. There was no significant between-group difference in the healing rate (chi-square test). However, the frequency of dressing changes was significantly lower (p < 0.001) and the healing time was significantly shorter (p = 0.0194) in the TNPT group than in the non-TNPT group. The 2-year OS rate was significantly higher in the TNPT group (p = 0.0473, log-rank test). CONCLUSION TNPT promoted wound healing after surgery for PCF and improved the 2-year OS rate. This tool is worthy of clinical application and promotion.
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Affiliation(s)
- Zhangwei Hu
- Department of Otolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Otorhinolaryngology Institute, Sun Yat-sen University, Guangzhou, China
| | - Xueqin Guo
- Department of Otolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Otorhinolaryngology Institute, Sun Yat-sen University, Guangzhou, China
| | - Lin Chen
- Department of Otolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Otorhinolaryngology Institute, Sun Yat-sen University, Guangzhou, China
| | - Wenbin Lei
- Department of Otolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Otorhinolaryngology Institute, Sun Yat-sen University, Guangzhou, China
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Botulinum Neurotoxin A in the Treatment of Pharyngocutaneous Fistula after Salvage Surgery in Head and Neck Cancer Patients: Our Preliminary Results. Curr Oncol 2022; 29:7099-7105. [PMID: 36290834 PMCID: PMC9601243 DOI: 10.3390/curroncol29100557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 01/13/2023] Open
Abstract
Objective: To analyze the effect of intraparotid injection of botulinum neurotoxin A (BoNT-A) on salivary production and the course of pharyngocutaneous fistula (PCF) in post-radiation therapy salvage surgery. Methods: A total of 13 patients who had undergone total laryngectomy or pharyngolaryngectomy were treated with BoNT-A to both parotid glands, within three days from PCF onset. The salivary flow was evaluated using a subjective rating scale as the percentage of normal function from 0% (no saliva) to 100% (normal saliva flow), before injection, every day for 2 weeks, and once a week for three months. PCFs were monitored daily. Results: Spontaneous closure of PCF occurred in 7/13 (53.84%) cases 13.6 days (range: 7-18) after treatment; 6/13 (46.16%) patients needed revision surgery. Salivary flow significantly decreased in all patients seven days after injection (from 67.2% to 36.4%; p < 0.05). Patients who had undergone either conservative or surgical treatment did not differ in salivary flow before injection, whereas the mean percentages of salivary flow calculated at each time point after injection were different (p < 0.05). Conclusions: BoNT-A contributed to the closure of the fistula in most of our cases. The subjective perception of salivary flow predicted the closure of PCF. The mean time to closure may contribute to establishing the timing of PCF surgical treatment.
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Choi BH, Park SO, Ahn HC. Reconstructive methods to resolve intractable fistulas that develop after radiation therapy in patients with head and neck cancer. Arch Craniofac Surg 2021; 22:247-253. [PMID: 34732036 PMCID: PMC8568500 DOI: 10.7181/acfs.2021.00353] [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] [Received: 08/09/2021] [Accepted: 10/20/2021] [Indexed: 11/30/2022] Open
Abstract
Background Radiation therapy (RT) is frequently used for supportive treatment and management of advanced head and neck cancers. This study performed a retrospective review of the treatment methods that were used for intractable draining fistulas in seven patients who had received RT for head and neck cancers. Treatment methods used for two of the seven patients are presented in detail. Methods From 2009 to 2020, seven patients underwent reconstructive surgery for intractable fistulas which occurred after RT for head and neck cancers. Patient characteristics, medical history, treatment method, and treatment outcome were reviewed for each case. The type of surgery performed, failure rate, and treatment period were also analyzed. Results In this study, a total of seven patients received additional management for radiation-induced fistulas. Patients underwent a mean of 3.3± 1.4 surgeries (maximum: six surgeries) to resolve their fistulas. The mean time interval from the first surgery to the last surgery for the patients to achieve resolution of the fistula was 8.7 months. Loco-regional flaps have performed an average of 1.9± 1.5 times. However, all loco-regional flaps failed. Instead, the patients’ intractable fistulas were resolved with the use of distant flaps or free tissue transfers. Conclusion Fistulas that develop after head and neck cancer treatment following RT are difficult to treat with simple loco-regional flap procedures. Therefore, more aggressive treatment techniques, such as distant flap or free tissue transfer, may be needed to shorten patients’ treatment periods and avoid unnecessary surgeries.
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Affiliation(s)
- Bu Hyeon Choi
- Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Seong Oh Park
- Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Hee Chang Ahn
- Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, Seoul, Korea
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Molteni G, Sacchetto A, Sacchetto L, Marchioni D. Optimal Management of Post-Laryngectomy Pharyngo-Cutaneous Fistula . OPEN ACCESS SURGERY 2020. [DOI: 10.2147/oas.s198038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Alain C, Fortier P, Belzile M. The infraclavicular pedicled flap in head and neck reconstruction: applications and outcomes. Head Neck 2019; 42:77-84. [DOI: 10.1002/hed.25990] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/04/2019] [Accepted: 09/17/2019] [Indexed: 11/06/2022] Open
Affiliation(s)
- Charles Alain
- Faculty of Medicine and Health SciencesUniversité de Sherbrooke Québec Canada
| | - Pierre‐Hugues Fortier
- Faculty of Medicine and Health Sciences, Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Centre intégré universitaire de santé et de services sociaux de l'Estrie‐Centre Hospitalier Universitaire de SherbrookeUniversité de Sherbrooke Québec Canada
| | - Mathieu Belzile
- Faculty of Medicine and Health Sciences, Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Centre intégré universitaire de santé et de services sociaux de l'Estrie‐Centre Hospitalier Universitaire de SherbrookeUniversité de Sherbrooke Québec Canada
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Sumarroca A, Rodríguez-Bauzà E, Lop-Gros J, García J, López M, Quer M, León X. Repair of post-laryngectomy pharyngocutaneous fistulas using a pectoralis major flap. Braz J Otorhinolaryngol 2019; 85:351-356. [PMID: 29650373 PMCID: PMC9442886 DOI: 10.1016/j.bjorl.2018.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 01/21/2018] [Accepted: 03/01/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction The pectoralis major flap is a reconstructive option to consider in the treatment of pharyngocutaneous fistula after a total laryngectomy. There are not large studies assessing variables related to pharyngocutaneous fistula recurrence after removal of the larynx. Our objectives were to review the results obtained with this type of treatment when pharyngocutaneous fistula appears in laryngectomized patients, and to evaluate variables related to the results. Methods We retrospectively reviewed our results using either a myocutaneous or fasciomuscular pectoralis major flap to repair pharyngocutaneous fistula in 50 patients. Results There were no cases of flap necrosis. Oral intake after fistula repair with a pectoralis major flap was restored in 94% of cases. Fistula recurrence occurred in 22 cases (44%), and it was associated with a lengthening of the hospital stay. Performing the flap as an emergency procedure was associated with a significantly higher risk of fistula recurrence. Hospital stay was significantly shorter when a salivary tube was placed. Conclusions The pectoralis major flap is a useful approach to repair pharyngocutaneous fistula. Placing salivary tubes during fistula repair significantly reduces hospital stay and complication severity in case of pharyngocutaneous fistula recurrence.
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Affiliation(s)
- Anna Sumarroca
- Universitat Autònoma de Barcelona, Hospital de la Santa Creu i Sant Pau, Otorhinolaryngology Department, Barcelona, Spain.
| | - Elena Rodríguez-Bauzà
- Universitat Autònoma de Barcelona, Hospital de la Santa Creu i Sant Pau, Plastic Surgery Department, Barcelona, Spain
| | - Joan Lop-Gros
- Universitat Autònoma de Barcelona, Hospital de la Santa Creu i Sant Pau, Otorhinolaryngology Department, Barcelona, Spain
| | - Jacinto García
- Universitat Autònoma de Barcelona, Hospital de la Santa Creu i Sant Pau, Otorhinolaryngology Department, Barcelona, Spain
| | - Montserrat López
- Universitat Autònoma de Barcelona, Hospital de la Santa Creu i Sant Pau, Otorhinolaryngology Department, Barcelona, Spain
| | - Miquel Quer
- Universitat Autònoma de Barcelona, Hospital de la Santa Creu i Sant Pau, Otorhinolaryngology Department, Barcelona, Spain
| | - Xavier León
- Universitat Autònoma de Barcelona, Hospital de la Santa Creu i Sant Pau, Otorhinolaryngology Department, Barcelona, Spain
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Pharyngocutaneous and tracheoesophageal fistula closure using supraclavicular artery island flap. Eur Arch Otorhinolaryngol 2018; 275:1921-1926. [DOI: 10.1007/s00405-018-4961-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
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Hinge Flap with Triangular Extension for Reconstruction of Pharyngocutaneous and Laryngocutaneous Fistulas. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1630. [PMID: 29464162 PMCID: PMC5811292 DOI: 10.1097/gox.0000000000001630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/10/2017] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Hinge flaps are commonly used for closure of a pharyngocutaneous fistula (PCF) or laryngocutaneous fistula. These flaps are employed to augment the wall of the pharynx or larynx, but the junction between the reconstructed and native lumens can eventually become narrow and irregular after reconstruction with standard hinge flaps. We devised a method of adding a triangular extension to the end of either or both flaps and used it to treat 3 patients. In 1 patient who developed a PCF (4 × 10 cm) after laryngectomy followed by radiotherapy, the fistula was closed with 2 hinge flaps. One flap had a caudal triangular extension. The residual skin defect was covered by a pedicled latissimus dorsi musculocutaneous flap. Another patient who developed a PCF (2.5 × 3 cm) after laryngectomy underwent 2-stage reconstruction using a buccal mucosal graft with a triangular extension, followed by 2 hinge flaps. A patient who developed an laryngocutaneous fistula (1 × 2 cm) after radiotherapy and subsequent partial laryngectomy underwent reconstruction using 2 hinge flaps, each of which had a triangular extension. The skin defect was covered by another flap. Postoperative CT or video fluoroscopic examination of swallowing showed a smooth lumen with no strictures in all 3 patients. The triangular extension of the hinge flap supplements the pharyngeal/laryngeal wall at the junction between the reconstructed and intact regions, thus avoiding postoperative stricture. Especially with PCF reconstruction, restoration of a smooth luminal surface minimizes dysphagia.
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Simple Septocutaneous Free Flap Design for One-Stage Reconstruction of Pharyngocutaneous and Orocutaneous Fistulae. J Craniofac Surg 2017; 28:1828-1832. [DOI: 10.1097/scs.0000000000003822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abt NB, Srikanth P, Puram SV, Deschler DG. Repair of complex pharyngocutaneous fistula using a staged temporoparietal fascial flap. Am J Otolaryngol 2017; 38:254-256. [PMID: 27916282 DOI: 10.1016/j.amjoto.2016.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/22/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION PCF is the most common major complication after salvage total laryngectomy (TL), especially for previously irradiated patients with laryngeal or hypopharyngeal cancer. METHODS/RESULTS A 65-year-old woman presented with recurrent bilateral supraglottic SCC requiring salvage TL 5.5years after initial T1N0M0 epiglottic SCC resection. Her post-operative course was complicated by PCF development one month post-operatively and surgical fistula closure was delayed for adjuvant chemoradiotherapy. The fistula persisted despite local wound therapy, several primary closures, pectoralis flap reconstruction with multiple revisions, and extensive hyperbaric oxygen treatments. Given her prior history, she underwent a staged right temporoparietal fascial flap reconstruction for persistent complex fistula, with second-stage flap takedown and complete inset of the TPFF skin island into the PCF. CONCLUSION This case demonstrates the utility of staged TPFF in complex PCF repair, with minimal morbidity, especially in a patient with prior irradiation and flap use that complicates tissue availability.
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Affiliation(s)
- Nicholas B Abt
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
| | - Priya Srikanth
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Daniel G Deschler
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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Hirano T, Iwasaki T, Fujita K, Takeno S, Suzuki M. Repair of a large pharyngocutaneous fistula with a free jejunal patch flap after salvage laryngectomy: A case report. Microsurgery 2015; 37:61-65. [PMID: 26269390 DOI: 10.1002/micr.22464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 05/27/2015] [Accepted: 07/17/2015] [Indexed: 11/08/2022]
Abstract
Preoperative chemoradiation therapy increases the risk of pharyngocutaneous fistula (PCF) after laryngectomy. In this report, we describe the use of a free jejunal patch flap and a deltopectoral flap for surgical treatment of a large PCF. A 52-year-old man underwent salvage laryngectomy and right neck dissection after concurrent radiotherapy for laryngeal carcinoma. On postoperative day 5, a pharyngeal fistula and neck abscess occurred with the right internal jugular vein thrombosis. We sutured the pharyngeal mucosa to the cervical skin to avoid carotid artery exposure, and we also ligated the right internal jugular vein. The PCF developed afterwards. The patient was being fed through a nasogastric tube and the fistula had increased in size. At the time of surgery, the external orifice became 5 cm × 5 cm in size. We performed the repair with a free jejunal patch flap and a deltopectoral flap. The harvested jejunum was opened along its antimesenteric border to design a sufficient free jejunal flap to cover the large PCF. A deltopectoral pedicled flap was used to reconstruct the neck skin defect to resurface the free jejunal patch flap. Both flaps survived. The patient could resume an oral diet 2 weeks after surgery. At 1 month after surgery, the skin pedicle of the deltopectoral flap was divided. There was no contracture or stricture 3 years after surgery and he maintained a regular diet. Reconstruction with a free jejunal patch flap and a deltopectoral flap may be a suitable method for repair of a large PCF. © 2014 Wiley Periodicals, Inc. Microsurgery 37:61-65, 2017.
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Affiliation(s)
- Takashi Hirano
- Department of Otolaryngology, Faculty of Medicine, Oita University, Oita, Japan
| | - Taro Iwasaki
- Department of Otolaryngology, Faculty of Medicine, Oita University, Oita, Japan
| | - Keigo Fujita
- Department of Otolaryngology, Faculty of Medicine, Oita University, Oita, Japan
| | - Shinsuke Takeno
- Department of Surgery II, Faculty of Medicine, Oita University, Oita, Japan.,Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Masashi Suzuki
- Department of Otolaryngology, Faculty of Medicine, Oita University, Oita, Japan
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Neubauer P, Cañadas K, Sasaki CT. Delayed platysma myocutaneous turnover flap for repair of pharyngocutaneous fistula. Am J Otolaryngol 2015; 36:93-6. [PMID: 25241029 DOI: 10.1016/j.amjoto.2014.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 08/27/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Pharyngocutaneous fistula (PCF) is a common and serious complication after total laryngectomy. Numerous surgical and non-surgical treatment approaches have been described. Here we describe a platysma myocutaneous turnover flap for repair of PCF. MATERIALS AND METHODS Platysma myocutaneous turnover flap is described and two patients are used as examples. RESULTS Repair was initially successful in both patients; however, one patient had recurrence of fistula after her cancer recurred at the stoma. DISCUSSION Numerous surgical techniques have been described for repair of PCF. Here a turnover flap was used, a technique not previously described for this problem. The delay technique enhances the viability of the flap thought to be through numerous mechanisms. CONCLUSION The platysma myocutaneous turnover flap is useful for closure of pharyngocutaneous fistula when non-operative measures have failed.
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Fink DS, Peña S, Hanby D, Kunduk M, McWhorter AJ. Repair of pharyngocutaneous fistula after total laryngectomy: A novel endoscopic approach. Head Neck 2014; 37:E81-4. [PMID: 25351470 DOI: 10.1002/hed.23911] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/24/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Pharyngocutaneous fistula (PCF) is a common and challenging complication of laryngectomy. The purpose of this study was to evaluate the results of endoscopic repair of postlaryngectomy PCF. METHODS Five patients who underwent salvage laryngectomy complicated by PCF underwent endoscopic repair at a regional medical center between 2006 and 2013. Data were compiled through a manual chart review and demographic data, adjuvant treatment, comorbidities, and clinical course were all recorded. RESULTS Five patients underwent endoscopic repair of PCF. All patients had previously received radiation or chemoradiation therapy and underwent salvage total laryngectomy. The mean number of days to resumption of oral intake after endoscopic repair was 22 days. One patient required reoperation. No complications were noted. CONCLUSION Endoscopic suture repair can be an effective method for treating PCF with less morbidity than flap reconstruction or conservative wound management.
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Affiliation(s)
- Daniel S Fink
- Our Lady of the Lake Voice Center, Baton Rouge, Louisiana.,Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Sarah Peña
- Our Lady of the Lake Voice Center, Baton Rouge, Louisiana
| | - Duncan Hanby
- Our Lady of the Lake Voice Center, Baton Rouge, Louisiana
| | - Melda Kunduk
- Our Lady of the Lake Voice Center, Baton Rouge, Louisiana.,Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Department of Communication Sciences and Disorders, Louisiana State University, Baton Rouge, Louisiana
| | - Andrew J McWhorter
- Our Lady of the Lake Voice Center, Baton Rouge, Louisiana.,Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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Abstract
Radiotherapy forms an integral part in cancer treatment today. It is used alone or in combination with surgery and chemotherapy. Although radiotherapy is useful to effect tumour death, it also exerts a deleterious effect on surrounding normal tissues. These effects are either acute or can manifest months or years after the treatment. The chronic wounds are a result of impaired wound healing. This impairment results in fibrosis, nonhealing ulcers, lymphoedema and radionecrosis amongst others. This article will discuss the pathophysiology in brief, along with the manifestations of radiation-induced injury and the treatment available currently.
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Affiliation(s)
- Subramania Iyer
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India ; Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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McLean JN, Nicholas C, Duggal P, Chen A, Grist WG, Losken A, Carlson GW. Surgical management of pharyngocutaneous fistula after total laryngectomy. Ann Plast Surg 2012; 68:442-5. [PMID: 21734542 DOI: 10.1097/sap.0b013e318225832a] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The increased use of radiation in the primary management of laryngeal carcinoma has resulted in an increase in pharyngocutaneous fistula (PCF) formation after salvage laryngectomy. The impact of this practice on surgical management strategies has been analyzed. METHODS A retrospective review of 177 patients treated by total laryngectomy for laryngeal or hypopharyngeal squamous cell carcinoma was performed. PCF formation was documented and management strategies were analyzed. RESULTS Preoperative radiation therapy (XRT) was administered to 86 patients (48.6%). Postoperative PCF developed in 47 patients (26.5%), including 30 (34.9%) who had received preoperative XRT versus 17 (18.6%) who had not received XRT (P = 0.015). Spontaneous PCF closure occurred in 23 patients (48.9%). Two patients died with persistent, untreated PCF. Surgical closure of PCF was performed in 22 patients (46.8%), including 17 who had received preoperative radiation (77.3%). Reconstructive methods included 9 local flaps, 17 pectoralis major (PM) flaps, and 2 free jejunal flaps. Seven of the 9 (77.8%) patients treated with local flaps had received XRT. Three patients had successful fistula closure including 2 who had not received radiation. Six of 9 patients (66.7%) developed recurrent fistulization after local flap closure necessitating PM flap closure. Overall, 14 patients (82.4%) had received preoperative XRT prior to PM flap closure. Six patients (35.3%) who had received XRT developed recurrent fistulization and 5 of these fistulas eventually closed with local wound care. The remaining patient succumbed to a carotid artery rupture. Two patients required a completion pharyngectomy and free jejunal flap reconstruction. PM flaps were used in both cases to provide soft-tissue coverage. CONCLUSIONS Preoperative XRT increases the risk of PCF after laryngectomy and the need for surgical closure. Local flap closure has a limited role in the surgical management of PCF. PM flap reconstruction has a high complication rate including recurrent fistulization in the setting of preoperative radiation.
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Affiliation(s)
- J Nicolas McLean
- Division of Plastic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Stathas T, Mallis A, Mastronikolis NS, Naxakis SS, Dimaka K, Panogeorgou T, Stavrou S, Margaritis V, Kourousis C, Papadas TA. Pharyngocutaneous fistula complicating laryngectomy: can metronidazole help? ORL J Otorhinolaryngol Relat Spec 2011; 73:291-4. [PMID: 21952008 DOI: 10.1159/000330275] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Accepted: 06/22/2011] [Indexed: 11/19/2022]
Abstract
AIM To evaluate the use of metronidazole as a prophylactic agent against pharyngocutaneous fistula (PCF) formation. PATIENTS AND METHODS Seventy patients who underwent total laryngectomy between 2000 and 2008 in our department were divided into two groups. The first group (M+ group) was placed on a 10-day metronidazole regimen (2 days prior to surgery and 7 days following). The second group (M- group) received only regular preoperative chemoprophylaxis. RESULTS In total, 17 (24.3%) incidents of PCF were reported, 3 of which were in the M+ group, with the remainder in the M- group. A statistically significant reduction in the PCF rate was noted in favor of metronidazole in the overall population (p = 0.005), as well as in the patient group that had received radiotherapy prior to surgery (p = 0.03). CONCLUSION Metronidazole administered for a total of 10 days pre- and postoperatively seems to lower the incidence rate of PCF formation.
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Karakullukcu MB, Lohuis PJ, van den Brekel MW, Hilgers FJ. Sealing of small postlaryngectomy pharyngocutaneous fistulas with voice prosthesis. Laryngoscope 2010; 120:1971-3. [DOI: 10.1002/lary.21071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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