title: Neck Incision Planning for Total Laryngectomy with Pharyngectomy.
abstract: OBJECTIVE
  To investigate the effect of skin incision location for total laryngectomy with pharyngectomy (TLP) on postoperative outcomes including wound dehiscence and infection rate.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Academic tertiary care center.
  
  
  METHODS
  A retrospective analysis was conducted of all patients undergoing TLP with flap closure at Johns Hopkins Medical Institutes between August 2005 and February 2013. The effects of patient characteristics and skin incision technique on postoperative wound dehiscence and infection were analyzed using cross-tabulations and multivariate regression modeling.
  
  
  RESULTS
  A total of 49 patients were included in the analysis; 31 received low-neck apron (LNA) incisions with an incorporated tracheostoma, while the remaining 18 had mid-neck apron (MNA) incisions with separate tracheostoma fashioned inferior to their incisions. Of these patients, 17 experienced incisional wound dehiscence (35%), and 18 contracted postoperative infections (37%). Generalized linear regression models demonstrated a significantly increased odds of wound dehiscence for patients with LNA incisions (odds ratio 29.8; 95% CI, 1.4-631.5, P = .029). There were no significant predictive variables for postoperative infection.
  
  
  CONCLUSIONS
  These results demonstrate that the use of a separately fashioned tracheostoma with MNA incision is associated with decreased rate of wound dehiscence in patients undergoing TLP.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: James H
authors.initials: JH
authors.lastname: Clark
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Allen L
authors.initials: AL
authors.lastname: Feng
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Katie
authors.initials: K
authors.lastname: Morton
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Nishant
authors.initials: N
authors.lastname: Agrawal
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA jrichmo7@jhmi.edu.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Richmon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007825:Laryngectomy / Q000379:methods*; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D009333:Neck / Q000601:surgery*; D010347:Patient Care Planning; D010611:Pharyngectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology; D014139:Tracheostomy
keywords: neck incision; surgical incision; total laryngectomy; total laryngopharyngectomy; wound dehiscence