title: Closure of laryngectomy defects in the age of chemoradiation therapy.
abstract: The use of chemoradiation therapy in laryngeal cancer has resulted in significant reconstructive challenges. Although reconstruction of salvage laryngectomy defects remains controversial, current literature supports aggressive management of these defects with vascularized tissue, even when there is sufficient pharyngeal tissue present for primary closure. Significant advancement in reconstructive techniques has permitted improved outcomes in patients with advanced disease who require total laryngopharyngectomy or total laryngoglossectomy. Use of enteric and fasciocutaneous flaps result in good patient outcomes. Finally, wound complication rates after salvage surgery approach 60% depending on comorbid conditions such as cardiac insufficiency, hypothyroidism, or extent of previous treatment. Neck dehiscence, great vessel exposure, fistula formation, or cervical skin necrosis results in complex wounds that can often be treated initially with negative pressure dressings followed by definitive reconstruction. The timing of repair and approach to the vessel-depleted neck also present challenges in this patient population. Currently, there is significant institutional bias in the management of the patient with postchemoradiation salvage laryngectomy. Future prospective multi-institutional studies are certainly needed to more clearly define optimal treatment of these difficult patients.
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center Houston, Texas, USA.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Hanasono
authors.forename: Derrick
authors.initials: D
authors.lastname: Lin
authors.forename: Mark K
authors.initials: MK
authors.lastname: Wax
authors.forename: Eben L
authors.initials: EL
authors.lastname: Rosenthal
mesh_terms: D002173:Cancer Care Facilities; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D007825:Laryngectomy / Q000379:methods; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010611:Pharyngectomy / Q000379:methods; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D018570:Risk Assessment; D016879:Salvage Therapy; D013524:Surgical Flaps / Q000098:blood supply*; D016019:Survival Analysis; D013781:Texas; D016896:Treatment Outcome