title: Primary versus delayed tracheoesophageal puncture for laryngopharyngectomy with free flap reconstruction.
abstract: OBJECTIVE
  To determine whether postoperative complication rates and speech outcomes differ between patients undergoing primary versus secondary tracheoesophageal puncture following total laryngectomy with free flap reconstruction.
  
  
  METHODS
  Retrospective clinical study in a tertiary academic center.
  
  
  METHODS
  Between November 2004 and June 2010, 137 patients underwent total laryngectomy or laryngopharyngectomy with pharyngeal free flap reconstruction for malignant disease. Data was collected on patient and operative demographics, early postoperative complications, speech outcomes, and predictive factors for tracheoesophageal puncture failure.
  
  
  RESULTS
  Thirty patients (22%) had a primary tracheoesophageal puncture performed at the time of laryngectomy, 27 patients (20%) received secondary punctures (>3 months postlaryngectomy), and 80 patients (58%) never received a puncture. Patient and operative demographics were similar between groups (P < .05), apart from proportionately more hypopharyngeal tumors in the "no puncture" group (P < .002). Similar numbers of patients in primary and secondary puncture groups achieved intelligible speech (67% vs. 71%, P = .82) and both groups reported good patient-perceived voice-related quality of life. Salvage surgery and nonpatch radial forearm free flap reconstruction both trended toward increased early postoperative complication rates (P = .09).
  
  
  CONCLUSIONS
  There is no difference in the early postoperative complication rate for primary versus secondary tracheoesophageal puncture following total laryngectomy with concurrent free flap reconstruction. Radial forearm patch free flap reconstruction achieves good speech outcomes.
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294-0012, USA.
authors.forename: Catherine F
authors.initials: CF
authors.lastname: Sinclair
authors.forename: Eben L
authors.initials: EL
authors.lastname: Rosenthal
authors.forename: Nancy L
authors.initials: NL
authors.lastname: McColloch
authors.forename: J Scott
authors.initials: JS
authors.lastname: Magnuson
authors.forename: Reneé A
authors.initials: RA
authors.lastname: Desmond
authors.forename: Glenn E
authors.initials: GE
authors.lastname: Peters
authors.forename: William R
authors.initials: WR
authors.lastname: Carroll
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm / Q000601:surgery; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods*; D007831:Larynx, Artificial; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D010610:Pharyngeal Neoplasms / Q000473:pathology / Q000601:surgery; D010611:Pharyngectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000503:physiopathology; D011237:Predictive Value of Tests; D011677:Punctures; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013070:Speech Therapy; D013997:Time Factors; D016896:Treatment Outcome