Reconstruction of pharyngeal defects using AlloDerm and sternocleidomastoid muscle flap.
OBJECTIVE
To report our experience in reconstructing pharyngeal defects that cannot be closed primarily, using acellular dermal matrix (AlloDerm, LifeCell Corp., Branchburg, NJ) and sternocleidomastoid (SCM) muscle flap.


METHODS
Prospective, nonrandomized, nonblinded study in the setting of an academic tertiary care medical center.


METHODS
Fourteen patients underwent reconstruction of through-and-through defects of partial pharyngectomy for squamous cell carcinoma using AlloDerm graft. Primary closure of the defects was not possible because of substantial loss of pharyngeal tissue. The graft was reinforced with superiorly based SCM muscle flap in 10 patients. The remaining four patients did not receive any flap. Eleven lesions involved the lateral pharyngeal wall, and three were piriform sinus lesions. Patients were followed for a period ranging from 3 to 20 months. Outcome measures were determined on several parameters including graft take rate, evidence of graft contracture, postoperative complications, resumption of diet, intelligibility of speech, and decannulation. All patients were evaluated by a speech pathologist by means of a bedside swallowing examination. Five patients had videofluoroscopic studies. The three patients with piriform sinus lesions underwent videostroboscopic examination to assess vocal cord function.


RESULTS
There was a high success rate for graft take. Two patients developed postoperative fistulas that resolved with conservative management. One of the 10 patients with SCM flap and one of the 4 patients without SCM flap developed fistulas. Clinically significant graft contracture or pharyngeal stenosis was not observed in any patients. All patients resumed oral intake. Ten patients resumed a normal diet, two tolerated a soft diet, and two could take purees. Decannulation was successful in all patients. Two of the three patients with piriform sinus lesions had vocal cord palsies after surgery resulting in breathy dysphonia. They underwent type I thyroplasty for vocal rehabilitation. All patients had intelligible speech.


CONCLUSIONS
Thick AlloDerm, reinforced with SCM muscle or cervical soft tissue, provides a useful alternative option for reconstruction of pharyngeal defects that cannot be closed primarily. It is safe and effective and provides excellent functional outcomes.
Sinha
U K
UK
Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA. sinha@hsc.usc.edu
Chang
K E
KE
Shih
C W
CW
D001672:Biocompatible Materials; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D003094:Collagen; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010610:Pharyngeal Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome
C440568:Alloderm; D001672:Biocompatible Materials; D003094:Collagen