Functional outcomes of fasciocutaneous free flap and pectoralis major flap for salvage total laryngectomy

Head & Neck ◽  
2017 ◽  
Vol 39 (9) ◽  
pp. 1797-1805 ◽  
Author(s):  
Sally Nguyen ◽  
François Thuot
Keyword(s):  
Free Flap ◽  
Functional Outcomes ◽  
Total Laryngectomy ◽  
Pectoralis Major ◽  
Pectoralis Major Flap

Pectoralis Major Onlay vs Interpositional Reconstruction Fistulation After Salvage Total Laryngectomy: Systematic Review and Meta-analysis

2020 ◽  
pp. 019459982095796
Author(s):  
Claudia I. Cabrera ◽  
Alexander Joseph Jones ◽  
Noah Philleo Parker ◽  
Amy Emily Lynn Blevins ◽  
Mark S. Weidenbecher
Keyword(s):  
Systematic Review ◽  
Total Laryngectomy ◽  
Primary Closure ◽  
Conservative Therapy ◽  
Meta Analysis ◽  
Pectoralis Major ◽  
Pectoralis Major Flap ◽  
The Difference ◽  
Meta Analyses ◽  
English Articles

Objective To evaluate the difference in pharygocutaneous fistula (PCF) development between pectoralis major flap onlay and interpositional reconstructions after salvage total laryngectomy (STL). Data Sources Medline, Cochrane, Embase, Web of Science, CINAHL, and ClinicalTrials.gov. Review Methods A systematic review was performed during January 2020. English articles were included that described minor and major PCF rates after STL reconstructed with pectoralis major onlay or interposition. PCFs were classified as major when conservative therapy was unsuccessful and/or revision surgery was needed. Articles describing total laryngopharyngectomies were excluded. Meta-analyses of the resulting data were performed. Results Twenty-four articles met final criteria amassing 1304 patients. Three articles compared onlay with interposition, and 18 compared onlay with primary closure. Pectoralis interposition demonstrated elevated odds ratio (OR) of PCF formation as compared with onlay (OR, 2.34; P < .001). Onlay reconstruction reduced overall (OR, 0.32; P < .001) and major (OR, 0.21; P < .001) PCF development as compared with primary pharyngeal closure alone. Data were insufficient to compare interposition against primary closure. Conclusions This research shows evidence that pectoralis onlay after STL diminishes the odds of total and major PCF development. Pectoralis interposition reconstruction showed elevated odds of PCF formation as compared with pectoralis onlay.

Free flap combined with pectoralis major flap for reconstruction after total laryngopharyngectomy in patients with advanced hypopharyngeal carcinoma

2016 ◽  
Vol 136 (8) ◽  
pp. 841-846 ◽  
Author(s):  
Caiyun Zhang ◽  
Minhui Zhu ◽  
Mengjie Chen ◽  
Donghui Chen ◽  
Shicai Chen ◽  
...  
Keyword(s):  
Free Flap ◽  
Pectoralis Major ◽  
Hypopharyngeal Carcinoma ◽  
Pectoralis Major Flap

scholarly journals Predictors of Salivary Fistulas in Patients Undergoing Salvage Total Laryngectomy

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Shethal Bearelly ◽  
Steven J. Wang
Keyword(s):  
Total Laryngectomy ◽  
Statistical Significance ◽  
Pectoralis Major ◽  
Common Complication ◽  
Pectoralis Major Flap ◽  
Closure Technique ◽  
Salivary Fistula ◽  
Number Of Layers ◽  
Institutional Experience ◽  
Fistula Rate

Background. Salivary fistula is a common complication after salvage total laryngectomy. Previous studies have not considered the number of layers of pharyngeal closure and have not classified fistulas according to severity. Our objective was to analyze our institutional experience with salvage total laryngectomy, categorize salivary fistulas based on severity, and study the effect of various pharyngeal closure techniques on fistula incidence. Methods. Retrospective analysis of 48 patients who underwent salvage total laryngectomy, comparing pharyngeal closure technique and use of a pectoralis major flap with regard to salivary fistula rate. Fistulas were categorized into major and minor fistulas based on whether operative intervention was required. Results. The major fistula rate was 18.8% (9/48) and the minor fistula rate was 29.2% (14/48). The overall (major plus minor) fistula rate was 47.9%. The overall fistula and major fistula rates decreased with increasing the number of closure layers and with use of a pectoralis major flap; however, these correlations did not reach statistical significance. Other than age, there were no clinicopathologic variables associated with salivary fistulas. Conclusion. For salvage total laryngectomies, increasing the number of closure layers or use of a pectoralis major flap may reduce the risk of salivary fistula.

Functional Comparison after Reconstruction with a Radial Forearm Free Flap or a Pectoralis Major Flap for Cancer of the Tongue

2003 ◽  
Vol 128 (3) ◽  
pp. 412-418 ◽  
Author(s):  
Wan-Fu Su ◽  
Yi-Jan Hsia ◽  
Yen-Chine Chang ◽  
Shyi-Gen Chen ◽  
Hwa Sheng
Keyword(s):  
Free Flap ◽  
Speech Intelligibility ◽  
Dietary Habits ◽  
Pectoralis Major ◽  
Pectoralis Major Flap ◽  
Swallowing Function ◽  
Reconstruction Methods ◽  
Significant Difference ◽  
Radial Forearm ◽  
Tongue Reconstruction

OBJECTIVE: Numerous patients in Taiwan with tongue carcinoma require tongue reconstruction. We compared the abilities of 2 methods of tongue reconstruction to reserve tongue function. STUDY DESIGN AND SETTING: Sixty patients underwent resection of the tumors and reconstruction with a pectoralis major flap or a radial forearm flap. The Chinese articulation test was used to evaluate the place and manner of error production, and a questionnaire on dietary habits was used to evaluate deglutition 6 months to 10 years after reconstruction. RESULTS: Patients with the free flap had more intelligible speech. The questionnaire study showed no significant difference between the 2 groups in swallowing rating. Motility caused by flap pliability increased speech intelligibility more than it did on swallowing function. CONCLUSION: Our experience in a few selected patients shows that the functional outcome of tongue surgery is related to the reconstruction methods used (for speech) and to the extent of tongue resection (for swallowing).

Prevention of pharyngocutaneous fistula in salvage total laryngectomy: role of the pectoralis major flap and peri-operative management

2018 ◽  
Vol 132 (3) ◽  
pp. 246-251 ◽  
Author(s):  
P Sittitrai ◽  
C Srivanitchapoom ◽  
D Reunmakkaew
Keyword(s):  
Total Laryngectomy ◽  
Operative Management ◽  
Incidence Rates ◽  
Pectoralis Major ◽  
Control Group ◽  
Pharyngocutaneous Fistula ◽  
Pectoralis Major Flap ◽  
Operative Care ◽  
Fistula Rate ◽  
The Impact

AbstractObjective:This study aimed to evaluate the impact of an onlay pectoralis major flap in reducing the incidence of pharyngocutaneous fistula after salvage total laryngectomy and determine the complications of pectoralis major flap reconstruction.Methods:A retrospective study was conducted of consecutive patients who underwent salvage total laryngectomy between 1995 and 2016. The pharyngeal defects were primarily closed with or without the pectoralis major flap.Results:Of 64 patients, 34 had primary pharyngeal closure alone (control group) and 30 received an onlay pectoralis major flap (pectoralis major flap group). The overall fistula rate was 15.6 per cent, with 17.6 per cent occurring in the control group and 13.3 per cent in the pectoralis major flap group (p = 0.74). The incidence rates of voice failure (p = 0.02) and shoulder disability (p < 0.001) were significantly higher in the pectoralis major flap group.Conclusion:The pectoralis major flap in salvage total laryngectomy did not decrease the pharyngocutaneous fistula rate, and the incidence of flap-related complications was high. Appropriate surgical technique and post-operative care may reduce the incidence of pharyngocutaneous fistula.

Efficacy of the Myofascial Pectoralis Major Flap in the Reduction of Salivary Fistulas After Salvage Total Laryngectomy

2018 ◽  
Vol 69 (2) ◽  
pp. 99-104
Author(s):  
Carlos Miguel Chiesa Estomba ◽  
Jose Angel González García ◽  
Jon Alexander Sistiaga Suarez ◽  
Izaskun Thomas Arrizabalaga ◽  
Ekhiñe Larruscain Sarasola ◽  
...  
Keyword(s):  
Total Laryngectomy ◽  
Pectoralis Major ◽  
Pectoralis Major Flap

Preliminary Functional Outcomes and Quality of Life after Tongue Reconstruction with the Vastus Lateralis Myofascial Free Flap

2021 ◽  
Author(s):  
Armando De Virgilio ◽  
Andrea Costantino ◽  
Raul Pellini ◽  
Gerardo Petruzzi ◽  
Giuseppe Mercante ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Head And Neck ◽  
Free Flap ◽  
Functional Outcomes ◽  
Vastus Lateralis ◽  
Life Questionnaire ◽  
Donor Area ◽  
Tongue Reconstruction ◽  
Eortc Qlq

AbstractThe aim of the present study is to report our preliminary experience with the vastus lateralis myofascial free flap (VLMFF) for tongue reconstruction according to tongue and donor site functional outcomes. Twelve consecutive patients (F: 5; median age: 54.0 years, interquartile range or IQR 42.75–69.0) were included. The validated European Organization for Research and Treatment of Cancer of the Head and Neck 35 Quality of Life Questionnaire (EORTC QLQ-H&N35) and the performance status scale for head and neck cancer (PSS-HN) questionnaires were used to assess the health-related quality of life (HRQOL). The lower extremity functional scale (LEFS) was used to self-report the donor area function. All patients were successfully treated, and no VLMFF failure was detected during a median follow-up period of 10.5 months (IQR: 6.5–33.0). The HRQOL showed a median EORTC QLQ-H&N35 score of 56.0 (IQR: 50.0–72.5). The median PSS-HN score was 80.0 (IQR: 45.0–95.0), 75.0 (IQR: 62.5–100.0), 75.0 (IQR: 62.5–100.0) for “Normalcy of Diet,” “Public Eating,” and “Understandability of Speech,” respectively. The self-reported function of the lower extremities (donor area) showed a median LEFS of 59.0 (IQR: 32.5–74.0). This study reports optimistic data regarding the functional and quality of life outcomes after tongue reconstruction using VLMFF. Prospective controlled studies are needed to demonstrate advantages and disadvantages when compared with other reconstructive techniques.

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