The role of pectoralis major muscle flap in salvage total laryngectomy.
OBJECTIVE
To assess the utility of the pectoralis major muscle flap (PMMF) in patients undergoing salvage total laryngectomy.


METHODS
Retrospective cohort analysis.


METHODS
Tertiary care cancer center.


METHODS
The study included 461 patients who underwent laryngectomy. Eighty of them underwent salvage surgery with primary pharyngeal closure.


METHODS
Of the 80 patients, 69 (86%) underwent primary pharyngeal closure alone and 11 (14%) underwent a PMMF, which was used to buttress the pharyngeal suture line.


METHODS
Two hundred thirty-six variables were recorded for each patient. Complications related to pharyngeal closure were measured.


RESULTS
Sixty-four percent of the patients who underwent PMMF also underwent chemoradiation therapy as the initial definitive treatment compared with 25% in the non-PMMF group (P = .03). On multivariate analysis, chemoradiation therapy was the only independent predictor of pharyngocutaneous fistula formation (relative risk, 1.82; P = .02). Nevertheless, the pharyngocutaneous fistula rate was similar in the PMMF (27%) and the non-PMMF (24%) groups. Furthermore, similar durations of tube feeding, days to oral feeding, and hospitalization period were recorded in both groups.


CONCLUSIONS
The PMMF should be used judiciously as a surgical adjunct in high-risk patients, with the goal of minimizing the risk for the development of a pharyngocutaneous fistula.
Head and Neck Surgery Service, Department of Surgery, Memorial Sloan-KetteringCancer Center, New York, USA. ziv@baseofskull.org
Ziv
Z
Gil
Amar
A
Gupta
Ben
B
Kummer
Peter G
PG
Cordeiro
Dennis H
DH
Kraus
Jatin P
JP
Shah
Snehal G
SG
Patel
D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D006085:Graft Survival; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010369:Pectoralis Muscles / Q000637:transplantation*; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016879:Salvage Therapy; D013524:Surgical Flaps; D016896:Treatment Outcome