title: Pharyngolaryngectomy with free jejunal autograft reconstruction and tracheoesophageal voice restoration: Indications for replacements, microbial colonization, and indwelling times of the Provox 2 voice prostheses.
abstract: BACKGROUND
  The purpose of this prospective study was to investigate shunt-related and device-related complications and microbial colonization of voice prostheses in patients after pharyngolaryngectomy with jejunal autograft reconstruction in comparison to patients after standard laryngectomy.
  
  
  METHODS
  Nine patients after pharyngolaryngectomy with jejunal autograft reconstruction (group 1) and 14 patients after standard laryngectomy (group 2) equipped with the Provox(®) 2 voice prostheses were followed up over 2 years. Anamnestic data, documentation of shunt-related or device-related complications, the Provox(®) 2 indwelling time, and standard microbiological procedures of voice prostheses were used for analyses.
  
  
  RESULTS
  A total of 157 prostheses were replaced. No significant difference in mean prosthesis indwelling time (p = .45) was observed between group 1 (116 ± 114 days) and group 2 (129 ± 99 days). Patients with jejunal autograft reconstruction needed prosthesis replacements more frequently within the first 60 days after prosthesis insertion in comparison to patients after standard laryngectomy (p = .007). The main indication for replacement in both groups was the device leakage (group 1: 93.1%, group 2: 92.1%). Prostheses of group 1 were more often colonized with Staphylococcus aureus (p = .027) and Enterobacteriaceae (p = .015).
  
  
  CONCLUSIONS
  This study demonstrated that, in comparison with patients after standard laryngectomy, patients after jejunal autograft reconstruction have similar shunt-related and device-related complications and prosthesis indwelling times. Therefore, tracheoesophageal voice rehabilitation could be strongly recommended in these patients.
authors.affiliation: Department of Otorhinolaryngology, Division of Phoniatrics-Logopedics, Medical University of Vienna, Vienna, Austria.
authors.forename: Adrian
authors.initials: A
authors.lastname: Reumueller
authors.forename: Matthias
authors.initials: M
authors.lastname: Leonhard
authors.forename: Gudrun
authors.initials: G
authors.lastname: Mancusi
authors.forename: Johannes Nikolaus
authors.initials: JN
authors.lastname: Gaechter
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Bigenzahn
authors.forename: Berit
authors.initials: B
authors.lastname: Schneider-Stickler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015331:Cohort Studies; D015169:Colony Count, Microbial; D003131:Combined Modality Therapy; D004866:Equipment Contamination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007583:Jejunum / Q000601:surgery; D053208:Kaplan-Meier Estimate; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000534:rehabilitation / Q000601:surgery; D007825:Laryngectomy / Q000009:adverse effects* / Q000379:methods / Q000534:rehabilitation; D007831:Larynx, Artificial / Q000009:adverse effects* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D010610:Pharyngeal Neoplasms / Q000473:pathology / Q000534:rehabilitation / Q000601:surgery; D010611:Pharyngectomy / Q000009:adverse effects* / Q000379:methods / Q000534:rehabilitation; D011446:Prospective Studies; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013524:Surgical Flaps; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014833:Voice Quality