title: Fistula rates after salvage laryngectomy: comparing pectoralis myofascial and myocutaneous flaps.
abstract: OBJECTIVE
  Salvage laryngectomy after failed organ preservation often has a high complication rate, pharyngocutaneous fistulas being the most common. These fistulas increase morbidity, prolong hospitalization, and potentially delay adjuvant treatment. Fistula rates in the literature range from 3% to 65%. Use of the pectoralis flap to prevent fistula formation has been adopted as a common practice at our institution. A review of our experience using the overlay myofascial showed a higher than desired complication rate. The aim of this study is to assess whether the use of integrated myocutaneous flap results in a lower fistula rate.
  
  
  METHODS
  A retrospective review of 30 patients followed by a pilot study of 10 patients. All underwent salvage laryngectomy after failed organ preservation.
  
  
  METHODS
  The operation notes of 40 laryngectomy patients were analyzed. The patient/tumor characteristics, pretreatment, neck dissection, flap type, and fistula rate were documented.
  
  
  RESULTS
  The patient sample was 25% female. All patients received prior radiotherapy, but only 37.5% received prior chemoradiation. Neck dissections were performed in 80% of these patients, 76% of the myocutaneous group, and 84% of the myofascial group. Advanced tumor stage was found in 42% of the myofascial group and 52% of the myocutaneous group. Five of the 19 myofascial patients developed a fistula, whereas seven of the 21 myocutaneous patients developed a fistula.
  
  
  CONCLUSIONS
  The use of the pectoralis myocutaneous flap (PMCF) in this pilot series did not show a lower rate of fistula; other alternatives should be pursued to decrease this complication.
  
  
  METHODS
  4.
authors.affiliation: Department of Otolaryngology, the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, U.S.A.
authors.forename: Nabeel A
authors.initials: NA
authors.lastname: Khan
authors.forename: Jesus E
authors.initials: JE
authors.lastname: Medina
authors.forename: Jose A
authors.initials: JA
authors.lastname: Sanclement
authors.forename: Greg A
authors.initials: GA
authors.lastname: Krempl
mesh_terms: D017577:Cutaneous Fistula / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D005205:Fascia / Q000637:transplantation*; D005260:Female; D005402:Fistula / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007822:Laryngeal Neoplasms / Q000601:surgery; D007825:Laryngectomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009825:Oklahoma / Q000453:epidemiology; D010369:Pectoralis Muscles / Q000637:transplantation*; D010608:Pharyngeal Diseases / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome
keywords: Pharyngocutaneous fistula; integrated myocutaneous; laryngectomy; myofascial flap; pectoralis flap; squamous cell carcinoma