title: Tissue transfer to post-chemoradiation salvage laryngectomy defects to prevent pharyngocutaneous fistula: single-centre experience.
abstract: BACKGROUND
  In recent practice, we have used tissue transfer (pedicled or free flap) to augment the pharyngeal circumference of the neopharynx following salvage total laryngectomy, even in patients who have sufficient pharyngeal mucosa for primary closure. In this study, the rates of pharyngocutaneous fistula were compared in soft tissue flap reconstructed patients versus patients who underwent primary closure.
  
  
  METHODS
  A retrospective assessment was carried out of all patients who had undergone a salvage total laryngectomy between 2000 and 2010. The presence or absence of a pharyngocutaneous fistula was compared in those who received reconstruction closure versus those who received primary closure.
  
  
  RESULTS
  The reconstruction closure group (n= 7) had no incidence of pharyngocutaneous fistula, whereas the primary closure group (n= 38) had 10 fistulas, giving pharyngocutaneous fistula rates of 0 per cent versus 26 per cent, respectively.
  
  
  CONCLUSIONS
  The findings revealed a lower rate of pharyngocutaneous fistula with tissue transfer compared with primary closure of the neopharynx.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: J
authors.initials: J
authors.lastname: Powell
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: U R
authors.initials: UR
authors.lastname: Ullal
authors.affiliation: Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: O
authors.initials: O
authors.lastname: Ahmed
authors.affiliation: Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: M
authors.initials: M
authors.lastname: Ragbir
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: V
authors.initials: V
authors.lastname: Paleri
mesh_terms: D006801:Humans; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods; D017577:Cutaneous Fistula / Q000517:prevention & control / Q000209:etiology; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D008297:Male; D010608:Pharyngeal Diseases / Q000517:prevention & control / Q000209:etiology; D008875:Middle Aged; D005260:Female; D007822:Laryngeal Neoplasms / Q000601:surgery; D000368:Aged; D013524:Surgical Flaps; D019651:Plastic Surgery Procedures / Q000379:methods; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods; D010614:Pharynx / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control; D005402:Fistula / Q000517:prevention & control / Q000209:etiology; D000328:Adult; D016896:Treatment Outcome
keywords: Chemotherapy; Fistula; Free Flap; Laryngectomy; Pedicled Flap; Radiotherapy; Salvage Therapy