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.

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.

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.

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

scholarly journals Limited Bilateral Advancement of the Sternocostal Head of Pectoralis Major for Sternal Reconstruction: Preserving the Axillary Fold

2017 ◽  
Vol 102 (3-4) ◽  
pp. 189-195
Author(s):  
Warren M. Rozen ◽  
Ken G. W. Teo ◽  
Gausihi Sivarajah ◽  
Rafael Acosta
Keyword(s):  
Pectoralis Major ◽  
High Rate ◽  
Pectoralis Major Flap ◽  
Limited Sample ◽  
Wound Coverage ◽  
Caudal Portion ◽  
Sternal Reconstruction ◽  
The Right ◽  
Good Cosmesis ◽  
Rate Of Success

The introduction of well-vascularized flaps for infected sternotomy wound reconstruction has improved mortality rates dramatically. Multiple variations of the pectoralis major flap have been described in this context. However, unresolved limitations of this flap include poor cosmesis and problematic coverage of the inferior third of the sternotomy wound. We describe an approach to address these issues. The humeral attachments are preserved and bilateral muscles are advanced in a limited fashion. The left sternocostal head is advanced medially and rotated anticlockwise, using this portion to fill the upper half of the sternum while the caudal portion of the right pectoralis muscle is used as a turnover flap at the lower half of the wound. In all 25 patients, the anterior axillary fold was preserved bilaterally and the infection completely resolved. Complications included 3 cases of hematoma, 2 cases of coagulopathy, and 1 late bone sequestrum (aseptic). Although the study had a limited sample size, we had a high rate of success and few complications. With the preservation of bilateral axillary folds, good cosmesis, and adequate wound coverage, we recommend this modification of the pectoralis major flap in even complicated cases of mediastinitis.

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