scholarly journals Temporoparietal fascia free flap for pharyngeal coverage after salvage total laryngectomy

2011 ◽  
Vol 122 (3) ◽  
pp. 523-527 ◽  
Author(s):  
Kevin M. Higgins ◽  
Bruce Ashford ◽  
Boban M. Erovic ◽  
John Yoo ◽  
Danny J. Enepekides
Keyword(s):  
Free Flap ◽  
Total Laryngectomy ◽  
Temporoparietal Fascia

Role of the temporoparietal fascia free flap in salvage total laryngectomy

Head & Neck ◽  
2021 ◽  
Author(s):  
Gabriele Molteni ◽  
Luca Gazzini ◽  
Andrea Sacchetto ◽  
Riccardo Nocini ◽  
Daniele Marchioni
Keyword(s):  
Free Flap ◽  
Total Laryngectomy ◽  
Temporoparietal Fascia

S154 – Primary TEP and Patch Free-Flap Laryngectomy Reconstruction

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P128-P128 ◽  
Author(s):  
Tamer Abdel-Halim Ghanem ◽  
Justin McLarty ◽  
Farhad Ardeshirpour ◽  
Christopher F Baranano ◽  
Eben L Rosenthal ◽  
...  
Keyword(s):  
Free Flap ◽  
Total Laryngectomy ◽  
Demographic Data ◽  
Free Flaps ◽  
Fistula Formation ◽  
Increased Risk ◽  
Radial Forearm ◽  
Speech Therapist ◽  
Fistula Rate ◽  
Tracheoesophageal Puncture

Objectives 1. Assess speech outcomes for patients undergoing primary tracheoesophageal puncture (TEP) following total laryngectomy (TL) with patch free flap reconstruction. 2. Evaluate risk of fistulization following primary TEP vs. no TEP in patch free flap TL reconstruction. Methods Patients undergoing reconstruction with patch free-flaps following TL were studied retrospectively. Demographic data, surgical procedures, speech outcomes, and postoperative complications were collected. Patients were divided in 2 groups depending on whether TEP was performed at the time of ablation (primary TEP). Voice outcomes were assessed by a speech therapist. Results 77 patients underwent TL, mean age of 63 years. Glottis (60%), followed by hypopharynx (18%), and supraglottis (17%) were the most common tumor sites. Most patients had T3 and T4 disease (71%) on initial presentation, and there were 57% undergoing salvage total laryngectomy. The radial forearm fascioucutaneous free flap was used in 90% of the cases. Primary TEP was performed in 44 patients (57%), and only 1 of 33 patients underwent a TEP procedure secondarily. Voice outcomes for the TEP group were good. The overall fistula rate was 39%, half of which healed spontaneously. The fistula rate in the primary TEP group was 41%, and in the group not receiving primary TEP it was 36.7% (p=0.87). Conclusions Primary TEP performed at the time of free-flap patch reconstruction after TL enhances speech outcomes for patients, and does not lead to an increased risk in fistula formation.

scholarly journals CO2 Laser Division of Neo-Vallecula Improves Dysphagia in the Postlaryngectomy Patient: A Case Series and Review of the Literature

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Mohamad Z. Saltagi ◽  
Chelsey A. Wallace ◽  
Avinash V. Mantravadi ◽  
Michael W. Sim
Keyword(s):  
Co2 Laser ◽  
Free Flap ◽  
Total Laryngectomy ◽  
Harmonic Scalpel ◽  
Case Series ◽  
Review Of The Literature ◽  
Closure Technique ◽  
Endoscopic Procedures ◽  
Diagnosis And Management ◽  
Pharyngeal Reconstruction

Objectives. To review the literature on neo-vallecula diagnosis and management and to report our findings regarding 3 patients who developed neo-vallecula in the context of free-flap pharyngeal reconstruction following total laryngectomy. Methods. This case series reports three patients who developed a neo-vallecula following a laryngectomy and free-flap pharyngeal reconstruction. All three patients were treated with a CO2 laser endoscopic procedure. Results. Neo-vallecula formation is thought to be related to tension on the neopharyngeal closure or closure technique following total laryngectomy. Diagnosis may be obtained with swallow studies, videofluoroscopy, or endoscopy. Treatment has included external excision and endoscopic procedures such as stapling, harmonic scalpel excision, and laser removal. We utilized an endoscopic approach entailing the use of a CO2 laser to divide the neo-vallecula, and all our patients reported improvement in their dysphagia. Conclusions. Treatment of an anterior neo-vallecula endoscopically using a CO2 laser is an effective way to treat dysphagia in patients following total laryngectomy with free-flap pharyngeal reconstruction.

Reconstruction After Salvage Total Laryngectomy: A Cost-effectiveness Analysis

2020 ◽  
pp. 019459982093626
Author(s):  
Joseph R. Acevedo ◽  
Jeffrey C. Yu ◽  
Brian Cameron ◽  
Margaret Nurimba ◽  
Joel W. Hay ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Free Flap ◽  
Total Laryngectomy ◽  
Primary Closure ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Sensitivity Analyses ◽  
Health Utilities ◽  
Effectiveness Analysis ◽  
Pectoralis Flap

Objective To determine the most cost-effective reconstruction method after salvage total laryngectomy. Study Design Cost-effectiveness analysis Setting Tertiary care hospitals with head and neck oncologic and reconstructive surgeons. Subjects and Methods We constructed a Markov-based decision model to compare reconstruction by primary closure to pectoralis flap and free flap after salvage total laryngectomy. The model simulated disease with transition probabilities and health utilities found in primary literature and estimated the average overall cost of each reconstructive method using Medicare billing codes. Effectiveness was compared using quality-adjusted life years (QALYs). One-way and probabilistic sensitivity analyses were performed to scrutinize the conclusions of our model. Reconstruction methods were compared using incremental cost-effectiveness ratios (ICERs). In the United States, less than $150,000 per QALY gained is considered cost-effective (2019 US dollars). Results Our base case analysis revealed that primary closure was less expensive ($44,370) and yielded more QALYs (0.91) than both pectoralis ($45,163, 0.81 QALYs) and free flap ($46,244, 0.85 QALYs), making it the most cost-effective option. Between flaps, free flap was cost-effective over pectoralis flap (ICER = $27,025/QALY gained). Sensitivity analyses showed primary closure as cost-effective 69% of the time over either flap. These conclusions were sensitive to the health utilities (quality of life) of each method of reconstruction. Conclusion Tissue flaps to augment closure after salvage total laryngectomy are not always the most cost-effective reconstructive option. The long-term morbidity of flap surgery oftentimes outweighs the benefit of lowering fistula rates after surgery. Careful consideration must be taken when advising patients of their reconstructive options.

Chimeric Lateral Arm Free Flap to Treat Pharyngocutaneous Fistula After Total Laryngectomy

2019 ◽  
Vol 30 (8) ◽  
pp. 2401-2403
Author(s):  
Lucian Fodor ◽  
Magdalena Chirila ◽  
Raluca Sobec ◽  
Laura Sita ◽  
Marius Fodor
Keyword(s):  
Free Flap ◽  
Total Laryngectomy ◽  
Pharyngocutaneous Fistula

Radial Forearm Free‐Flap Reconstruction Following Radiotherapy and Total Laryngectomy

1999 ◽  
Vol 15 (01) ◽  
pp. 15-18 ◽  
Author(s):  
Yuhei Yamamoto ◽  
Hiroshi Furukawa ◽  
Tsuneki Sugihara ◽  
Satoshi Fukuda ◽  
Yasushi Furuta ◽  
...  
Keyword(s):  
Free Flap ◽  
Total Laryngectomy ◽  
Radial Forearm Free Flap ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Radial Forearm
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