Pectoralis myofascial flap during salvage laryngectomy prevents pharyngocutaneous fistula.
OBJECTIVE
To determine the rate of pharyngocutaneous fistula after salvage laryngectomy and assess if pectoralis myofascial flap reinforcement over primary pharyngeal closure prevents pharyngocutaneous fistula.


METHODS
Case series with chart review.


METHODS
Tertiary-care public hospital.


METHODS
This study included 43 patients undergoing total laryngectomy between 2003 and 2008. Pectoralis myofascial flap reinforcement of the pharyngeal closure during salvage laryngectomy was performed on patients after June 2006. The main outcome measure was pharyngocutaneous fistula after primary laryngectomy, salvage laryngectomy, and salvage laryngectomy with pectoralis flap reinforcement.


RESULTS
Of the 43 patients, 26 were treated with primary total laryngectomy while 17 received salvage laryngectomy. Seven of 26 patients (27%) undergoing primary total laryngectomy developed pharyngocutaneous fistula. All patients in this group were closed primarily with no flap reinforcement. For salvage laryngectomy, four of seven patients (57%) with primary pharyngeal closure developed pharyngocutaneous fistula; however, none of 10 patients (0%) undergoing salvage laryngectomy with pectoralis myofascial flap reinforcement developed fistula (P<0.02; 0%-23%; 95% CI).


CONCLUSIONS
With pectoralis myofascial flap reinforcement, pharyngocutaneous fistula rate after salvage laryngectomy dropped to 0 percent in this study (0%-23%; 95% CI). This is a simple, reliable technique that prevents postoperative pharyngocutaneous fistula and its associated morbidity after salvage laryngectomy.
Patel
Urjeet A
UA
Department of Otolaryngology-Head and Neck Surgery, Northwestern University, and Division of Otolaryngology-Head and Neck Surgery, Cook County Hospital, Chicago, IL 60611, USA. upatel3@ccbhs.org
Keni
Sanjay P
SP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017577:Cutaneous Fistula / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005402:Fistula / Q000517:prevention & control; D006785:Hospitals, University; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010369:Pectoralis Muscles; D010608:Pharyngeal Diseases / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D016879:Salvage Therapy / Q000379:methods; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome