Skip to main content

Pectoralis major flap reconstruction in the prevention of wound breakdown and fistula formation after salvage laryngectomy: a controlled study

En

Abstract

Background

Patients undergoing salvage laryngeal surgery after high-dose radiotherapy or concurrent chemotherapy/radiation therapy regimen are more prone to develop pharyngocutaneous fistulas (PCFs). The fistula rates reported are as high as 70%.

Aim of the study

The aim of this study was to assess the effectiveness of pectoralis major muscle flap (PMF) in prevention of fistula formation and in enhancing wound healing in patients undergoing salvage laryngectomy.

Patients and methods

We compared results from patients of salvage laryngectomy repaired with pectoralis major flap with those of a similar group repaired by primary wound closure in 36 consecutive patients. Group A included 16 patients who underwent PMF following salvage total laryngectomy (12 male and four female patients; median age 56 years; interquartile range, 49.8–61.8). The other group included 20 patients who underwent primary closure of the wound without PMF (group B) (15 male and five female patients; median age 43 years; interquartile range, 36–54). Minimum follow-up in both groups was 3 months.

Results

The incidence of PCF in group A was 6.2% and that of wound gap was 6.2%, and there was no carotid blowout. The results in group B were as follows: 60% PCF rate and poor wound healing with gapping in 40% of patients and carotid blowout in 25% of patients (P < 0.001). The mean duration to fistula closure was 20 days in group A compared with 57.5 days in group B.

Conclusion

Pectoralis major flap will give the patients the advantages of less fistula formation, good wound healing, early oral feeding, short hospital stay and protection against catastrophic vascular blowouts.

References

  1. 1

    Esteller E, Vega MC, López M, Quer M, León X. Salvage surgery after locoregional failure in head and neck carcinoma patients treated with chemoradiotherapy. Eur Arch Otorhinolaryngol 2011; 268: 295–301.

    CAS  Article  Google Scholar 

  2. 2

    Gil Z, Gupta A, Kummer B, Cordeiro PG, Kraus DH, Shah JP, Patel SG. The role of pectoralis major muscle flap in salvage total laryngectomy. Arch Otolaryngol Head Neck Surg 2009; 135: 1019–1023.

    Article  Google Scholar 

  3. 3

    Wakisaka N, Murono S, Kondo S, Furukawa M, Yoshizaki T. Post-operative pharyngocutaneous fistula after laryngectomy. Auris Nasus Larynx 2008; 35: 203–208.

    Article  Google Scholar 

  4. 4

    Riad MA, Hamdy TA, Sabra RMI, Adly A. Pectoralis major flap in the reconstruction after salvage laryngectomy: how I do it. Egypt J Otolaryngol 2013; 29: 145–148.

    Google Scholar 

  5. 5

    Paydarfar JA, Birkmeyer NJ. Complications in head and neck surgery: a metaanalysisof post laryngectomypharyngo-cutaneous fistula. Arch Otolaryngol Head Neck Surg 2006; 132: 67–72.

    Article  Google Scholar 

  6. 6

    Fung K, Teknos TN, Vandenberg CD, Lyden TH, Bradford CR, Hogikyan ND, et al. Prevention of wound complications following salvage laryngectomy using free vascularized issue. Head Neck 2007; 29: 425–430.

    Article  Google Scholar 

  7. 7

    Hanasono MM, Lin D, Wax MK, Rosenthal EL. Closure of laryngectomy defects in the age of chemoradiation therapy. Head Neck 2012; 34: 580–588.

    Article  Google Scholar 

  8. 8

    Furuta Y, Homma A, Oridate N, Suzuki F, Hatakeyama H, Suzuki K, et al. Surgical complications of salvage total laryngectomy following concurrent chemoradiotherapy. Int J Clin Oncol 2008; 13: 521–527.

    Article  Google Scholar 

  9. 9

    Patel UA, Keni SP. Pectoralis myofascial flap during salvage laryngectomy prevents pharyngocutaneous fistula. Otolaryngol Head Neck Surg 2009; 141: 190–195.

    Article  Google Scholar 

  10. 10

    Oosthuizen JC, Leonard DS, Kinsella JB. The role of pectoralis major myofascial flap in salvage laryngectomy: a single surgeon experience. Acta Otolaryngol 2012; 132: 1002–1005.

    CAS  Article  Google Scholar 

  11. 11

    Smith TJ, Burrage KJ, Ganguly P, Kirby S, Drover C. Prevention of postlaryngectomy pharyngocutaneous fistula: the Memorial University experience. J Otolaryngol 2003; 32: 222–225.

    Article  Google Scholar 

  12. 12

    Weber RS, Berkey BA, Forastiere A, Cooper J, Maor M, Goepfert H, et al. Outcome of salvage total laryngectomy following organ preservation therapy: the Radiation Therapy Oncology Group trial 91–11. Arch Otolaryngol Head Neck Surg 2003; 129:44–49.

    Article  Google Scholar 

  13. 13

    Sousa AA, Castro SM, Porcaro-Salles JM, Soares JM, de Moraes GM, Carvalho JR, Silva GS. The usefulness of a pectoralis major myocutaneous flap in preventing salivary istulae after salvage total laryngectomy. Braz J Otorhinolaryngol. 2012; 78: 103–107.

    Article  Google Scholar 

  14. 14

    Varghese BT, Sebastian P, Mathew A. Treatment outcome in patients undergoing surgery for carcinoma larynx and hypopharynx: a follow-up study. Acta Otolaryngol 2009; 129: 1480–1485.

    Article  Google Scholar 

  15. 15

    van der Putten L, de Bree R, Kuik DJ, Rietveld DH, Buter J, Eerenstein SE, Leemans CR. Salvage laryngectomy: oncological and functional outcome. Oral Oncol 2011; 47:296–301.

    Article  Google Scholar 

  16. 16

    Ganly I, Patel S, Matsuo J, Singh B, Kraus D, Boyle J, et al. Postoperative complications of salvage total laryngectomy. Cancer 2005; 103: 2073–2081.

    Article  Google Scholar 

  17. 17

    Gilbert MR, Sturm JJ, Gooding WE, Johnson JT, Kim S. Pectoralis major myofascial onlay and myocutaneous flaps and pharyngocutaneous fistula in salvage laryngectomy, 2014. The American Laryngological, Rhinological and Otological Society, Inc.

  18. 18

    Tsou YA, Hua CH, Lin MH, Tseng HC, Tsai MH, Shaha A. Comparison of pharyngocutaneous fistula between patients followed by primary laryngopharyngectomy and salvage laryngopharyngectomy for advanced hypopharyngeal cancer. Head Neck 2010; 32: 1494–1500.

    Article  Google Scholar 

  19. 19

    Kroll SS, Evans GR, Goldberg D, Wang BG, Reece GP, Miller MJ, et al. A comparison of resource costs for head and neck reconstruction with free and pectoralis major flaps. Plast Reconstr Surg 1997; 99: 1282–1286.

    CAS  Article  Google Scholar 

  20. 20

    Righini C, Lequeux T, Cuisnier O, Morel N, Reyt E. The pectoralis myofascial flap in pharyngolaryngeal surgery after radiotherapy. Eur Arch Otorhinolaryngol 2005; 262: 357–361.

    CAS  Article  Google Scholar 

  21. 21

    Sundaram K, Wasserman JM. Prevention of unplanned pharyngocutaneous fistula in salvage laryngectomy. Otolaryngol Head Neck Surg 2009; 141: 645–647.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Reda M. Sabra MD.

Additional information

Conflicts of interest

There are no conflicts of interest.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sabra, R.M., Taha, M.S., Hamdy, T.A. et al. Pectoralis major flap reconstruction in the prevention of wound breakdown and fistula formation after salvage laryngectomy: a controlled study. Egypt J Otolaryngol 32, 32–36 (2016). https://doi.org/10.4103/1012-5574.175803

Download citation

Keywords

  • fistula
  • flaps
  • laryngectomy
  • pectoralis major
  • reconstruction