title: Stomal recurrence: salvage surgery and reconstruction utilizing microvascular free tissue transfer.
abstract: BACKGROUND
  Stomal recurrence in patients after laryngectomy has a poor prognosis. Studies performed using sternal resection with pectoralis flap reconstruction report <25% 2-year survival. The purpose of this study was to ascertain whether the use of larger resection with free flap reconstruction improves survival.
  
  
  METHODS
  Thirteen cases of stomal recurrence that underwent extended sternal resection and free flap reconstruction were identified and classified according to Sisson criteria. Postoperative morbidity, mortality, and survival were assessed.
  
  
  RESULTS
  Median survival was 10 months in patients with Sisson types I and II, with 37.5% 1-year and 25% 2-year survival. Median survival was 6 months in patients with Sisson types III and IV, with 40% 1-year and 0% 2-year survival. There were 2 perioperative deaths and a major morbidity rate of 45%.
  
  
  CONCLUSIONS
  Salvage surgery using free flap reconstruction did not show improved survival rates compared with previously described techniques.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Loyola University Medical Center, Maywood, IL.
authors.forename: Amy
authors.initials: A
authors.lastname: Pittman
authors.forename: Robert
authors.initials: R
authors.lastname: Lindau
authors.forename: Peter
authors.initials: P
authors.lastname: Andersen
authors.forename: Mark K
authors.initials: MK
authors.lastname: Wax
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000601:surgery; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D013249:Sternum / Q000601:surgery*; D054047:Surgical Stomas
keywords: mediastinal dissection; microvascular reconstruction; parastomal resection; stomal reconstruction; stomal recurrence