title: Acellular dermal graft pharyngeal repair augmentation after laryngectomy.
abstract: OBJECTIVE
  Pharyngocutaneous fistula (PCF) after laryngectomy continues to be a serious complication, especially after radiation. Recruitment of non-radiated tissue into the surgical defect may decrease the risk of fistula. These techniques however have significant morbidity and increases operative time. We hypothesized that using acellular dermal graft to reinforce the pharyngeal closure could decrease the risk of fistula, without the added morbidity of a vascularized flap.
  
  
  METHODS
  We performed a retrospective chart review of all patients that underwent a laryngectomy between 2005 and 2015 at an acedemic tertiary referral center. Patients who underwent primary pharyngeal closure with Alloderm® reinforcement without any other flap reconstruction were identified. Basic demographics, previous treatment, operative technique and fistula were extracted from the medical records. The primary outcome was PCF rate. The time to closure, margin status and disease recurrence was also evaluated.
  
  
  RESULTS
  Among 16 patients with AlloDerm® augmentation, eight had primary laryngectomy and eight had salvage laryngectomy. A total of three in the salvage laryngectomy with prior history of radiation developed PCF. The fistula closed in all three cases with conservative treatment. There was no PCF in the primary laryngectomy group without prior history of radiation.
  
  
  CONCLUSIONS
  The rate of PCF among the salvage laryngectomy group with previous radiation did not differ from historical data. AlloDerm® can however, provide a simple alternative for repair in radiation patients where flap cannot be performed for pharyngeal reconstruction. In non-radiated patients, AlloDerm® augmentation may have a protective effect on fistula formation.
authors.affiliation: Washington University in St Louis, Department of Otolaryngology-Head and Neck Surgery, Saint Louis, MO, USA. Electronic address: pipkornp@ent.wust.edu.
authors.forename: Patrik
authors.initials: P
authors.lastname: Pipkorn
authors.affiliation: Washington University in St Louis, Department of Otolaryngology-Head and Neck Surgery, Saint Louis, MO, USA.
authors.forename: Parul
authors.initials: P
authors.lastname: Sinha
authors.affiliation: Washington University in St Louis, Department of Otolaryngology-Head and Neck Surgery, Saint Louis, MO, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Zenga
authors.affiliation: Medical University of South Carolina, Head and Neck Surgery, Charleston, SC, USA.
authors.forename: Evan
authors.initials: E
authors.lastname: Graboyes
authors.affiliation: Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, FL, USA; Department of Surgery, University of Auckland Faculty of Medicine and Health Sciences, Auckland, New Zealand.
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Haughey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003094:Collagen; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007825:Laryngectomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010610:Pharyngeal Neoplasms / Q000601:surgery*; D010614:Pharynx / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: C440568:Alloderm; D003094:Collagen