title: Pectoralis major myofascial onlay and myocutaneous flaps and pharyngocutaneous fistula in salvage laryngectomy.
abstract: OBJECTIVE
  To review the fistula rate in irradiated patients undergoing salvage laryngectomy, compare the effect of closure type on fistula rate, and examine possible perioperative risk factors that might contribute to an increased fistula rate.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  We conducted a retrospective review of the University of Pittsburgh head and neck tumor registry and identified 73 patients from 1998 to 2011 who had received prior radiation before total laryngectomy or salvage laryngectomy and who had either primary closure, pectoralis major myofascial (PMMF) flap onlay, or pectoralis major myocutaneous (PMMC) flap.
  
  
  RESULTS
  Fistula was more common in patients who underwent initial primary closure (45%) than in patients who had immediate PMMF onlay (10.5%). The fistula rate for patients who underwent immediate PMMC flap was 28.6%, intermediate to primary closure and PMMF flap. Several factors were evaluated for relationship to fistula, but no significant associations were identified. However, patients with fistula tended to have longer inpatient stays and may have been more likely to have a history of cardiovascular or hypoxic disease.
  
  
  CONCLUSIONS
  Pharyngocutaneous fistula is a well-established complication of total laryngectomy and is especially a concern in patients with a previous history of radiation. Our retrospective review demonstrates that PMMF onlay flap appears to be more effective in reducing the rate of fistula compared to primary closure in these patients. Myocutaneous augmentation flaps, in contrast, have a fairly high fistula rate and may be better replaced with alternative closures such as free flaps.
  
  
  METHODS
  4.
authors.affiliation: Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Gilbert
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Sturm
authors.forename: William E
authors.initials: WE
authors.lastname: Gooding
authors.forename: Jonas T
authors.initials: JT
authors.lastname: Johnson
authors.forename: Seungwon
authors.initials: S
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D007825:Laryngectomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D064827:Myocutaneous Flap; D010369:Pectoralis Muscles / Q000637:transplantation; D010614:Pharynx; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D016156:Respiratory Tract Fistula / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome
keywords: Laryngeal cancer; fistula; head and neck cancer; pectoralis major flap; radiation