title: Intraluminal negative pressure wound therapy for optimizing pharyngeal reconstruction.
abstract: OBJECTIVE
  Pharyngocutaneous fistula formation after pharyngeal reconstruction is one of the most common and challenging problems to manage. Despite many advances in management, the published success rates indicate a role for any adjuvant therapy that could potentially decrease this complication.
  
  
  OBJECTIVE
  To describe the use of intraluminal negative pressure dressings (NPDs) in pharyngeal reconstruction.
  
  
  METHODS
  Retrospective case series at a tertiary care academic hospital. Twelve laryngectomy patients underwent pharyngeal reconstruction augmented by placement of an intrapharyngeal NPD in combination with the introduction of vascularized tissue from August 2011 to May 2012. All patients had potential risk factors for compromised wound healing defined as previous radiation therapy, hypothyroidism, diabetes mellitus, compromised nutrition, or established pharyngocutaneous fistula.
  
  
  METHODS
  An NPD was placed in an intraluminal position spanning the length of the pharyngeal defect as part of the reconstructive procedure. The negative pressure sponge was attached to a standard nasogastric tube to which negative pressure was applied. External closure of the pharynx was then achieved with regional or free tissue transfer.
  
  
  METHODS
  Pharyngeal closure rates, timing until return to oral diet, identification of wound healing risk factors, and adverse events related to use of the device.
  
  
  RESULTS
  Eleven of 12 patients (92%) achieved pharyngeal closure with reconstruction using negative pressure wound therapy. All patients had at least 1 potential risk factor for compromised wound healing, with 11 of 12 (92%) having 2 or more. Seven patients had an established pharyngocutaneous fistula, and 5 patients underwent primary reconstruction after laryngopharyngectomy. In 6 of these 7 patients undergoing fistula repair, pharyngeal closure was achieved, and they resumed an oral diet at 1 week postoperatively. The other had successful leak repair initially, but 1 week later developed a separate area of wound breakdown and a second fistula. All 5 patients in whom an intraluminal NPD was placed at the time of initial vacularized tissue reconstruction were able to resume an oral diet by 3 weeks postoperatively, with 3 of them eating by mouth at 1 week postoperatively. No serious adverse events could be attributed to the use of intraluminal NPDs.
  
  
  CONCLUSIONS
  Intraluminal negative pressure wound therapy is feasible and safe. Future research should be conducted to determine its potential in optimizing pharyngeal reconstruction in high-risk patients.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine at the University of Alabama at Birmingham, Birmingham.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Asher
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine at the University of Alabama at Birmingham, Birmingham.
authors.forename: Hilliary N
authors.initials: HN
authors.lastname: White
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine at the University of Alabama at Birmingham, Birmingham.
authors.forename: Elisa A
authors.initials: EA
authors.lastname: Illing
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine at the University of Alabama at Birmingham, Birmingham.
authors.forename: William R
authors.initials: WR
authors.lastname: Carroll
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine at the University of Alabama at Birmingham, Birmingham.
authors.forename: J Scott
authors.initials: JS
authors.lastname: Magnuson
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine at the University of Alabama at Birmingham, Birmingham.
authors.forename: Eben L
authors.initials: EL
authors.lastname: Rosenthal
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000009:adverse effects / Q000379:methods; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D010608:Pharyngeal Diseases / Q000209:etiology / Q000601:surgery; D010610:Pharyngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D058106:Wound Closure Techniques; D014945:Wound Healing / Q000502:physiology