title: A minimally invasive method to prevent postlaryngectomy major pharyngocutaneous fistula using infrahyoid myofascial flap.
abstract: BACKGROUND
  To prevent postoperative pharyngocutaneous fistula (PCF) after total (pharyngo)laryngectomy, simultaneous coverage of pharyngeal anastomosis with vascularised flaps such as pectoralis major muscle, anterolateral thigh or radial forearm, has been reported to be effective. As an alternative to the invasive methods using distant flaps, we used the infrahyoid myofascial flap (IHMFF), which was harvested from the same operation field of (pharyngo)laryngectomy, for covering the site of pharyngeal anastomosis. Herein, we describe the safety and effectiveness of our minimally invasive method for preventing PCF.
  
  
  METHODS
  Eleven patients who were at a high risk of developing PCF due to previous chemoradiotherapy underwent simultaneous coverage of pharyngeal anastomosis with IHMFF after total (pharyngo)laryngectomy. The incidence of PCF and the rate of major fistula requiring surgical closure were determined, and the results were compared with the control group (23 patients without IHMFF cover after laryngectomy).
  
  
  RESULTS
  PCF developed in 2 of the 11 patients (18.2%). The fistulae of these two patients were closed conservatively and did not require additional surgery. PCF developed in 6 of 23 patients (26.1%) in patients without IHMFF cover. All the six patients with fistula required additional closure surgery. The incidence of PCF did not differ in patients with or without IHMFF cover (Fisher's exact probability test; p=0.939, NS). However, the rate of major PCF requiring surgical closure was significantly lower in patients with IHMFF cover (Fisher's exact probability test; p=0.036<0.05).
  
  
  CONCLUSIONS
  For (pharyngo)laryngectomy patients, IHMFF cover is a minimally invasive method that can prevent major PCF.
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. hkadota@hotmail.co.jp
authors.forename: Hideki
authors.initials: H
authors.lastname: Kadota
authors.forename: Junichi
authors.initials: J
authors.lastname: Fukushima
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kamizono
authors.forename: Muneyuki
authors.initials: M
authors.lastname: Masuda
authors.forename: Shunichiro
authors.initials: S
authors.lastname: Tanaka
authors.forename: Takamasa
authors.initials: T
authors.lastname: Yoshida
authors.forename: Torahiko
authors.initials: T
authors.lastname: Nakashima
authors.forename: Shizuo
authors.initials: S
authors.lastname: Komune
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D016022:Case-Control Studies; D015331:Cohort Studies; D017577:Cutaneous Fistula / Q000209:etiology / Q000517:prevention & control*; D005205:Fascia / Q000637:transplantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006928:Hyoid Bone; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery; D007825:Laryngectomy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009130:Muscle, Smooth / Q000637:transplantation; D010608:Pharyngeal Diseases / Q000209:etiology / Q000517:prevention & control; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply*; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome