Use of pectoralis major myofascial flap on the prevention of pharyngocutaneous fístula in salvage laryngectomy after chemoradiotherapy

Abstract

Background: Pharyngocutaneous fístula (PCF) is a major complication of salvage laryngectomies, mainly secondary to the effect of radiotherapy.

Aims/objectives: Our main objective is to study the effect of pectoralis major myofascial flap (PMMF) on the prevention of PCF.

Materials and methods: We studied all total laryngectomies (TL) performed between 2001 and 2018, noting the use of previous chemoradiation, the type of suture and the use of flaps. We recorded and compared the incidence of PCF in all groups.

Results: A total of 146 patients were included, divided into a primary TL group (117 patients) and salvage TL (29 patients). PMMF was used in 62% of salvage TLs. The rates of PCF were 5.98% in primary TL and 17.2% in salvage procedures. Among the salvage TL group, in patients with pharyngeal closure alone, a PCF developed in 36.4% of cases, compared to 5.56% in the PMMF group. We found a similar rate of fistulae when comparing primary TL and salvage TL with PMMF, highlighting the protective effect of the flap.

Conclusions and significance: The use of PMMF in salvage TL reduces the incidence of PCF, achieving a rate similar to that attained with primary TL.

Chinese abstract

背景：咽部皮肤损伤（PCF）是抢救性喉切除术的主要并发症, 仅次于放疗的影响。

目的：我们的主要目的是研究胸大肌肌筋膜瓣（PMMF）对预防PCF的作用。

材料和方法：我们研究了2001年至2018年间进行的所有全喉切除术（TL）, 注意到先前化学放射的使用、缝合类型和皮瓣使用。我们记录并比较了所有组中PCF的发生率。

结果：共纳入146例患者, 分为原发性TL组（117例）和抢救性TL组（29例）。 PMMF用于62％的抢救性TLs。原发性TL的PCF率为5.98％, 抢救手术的PCF率为17.2％。在抢救性T​​L组中的单独咽部闭合的患者中, PCF发生率为36.4％, 而PMMF组的PCF率为5.56％。我们发现, 当将原发性TL和用PMMF的抢救性TL进行比较时, 瘘管的发生率相似, 突出了皮瓣的保护作用。

结论和意义：在抢救性TL中使用PMMF降低了PCF的发生率, 取得与原发性TL相似的发生率。

Keywords:

• Pharyngocutaneous fístula
• pectoralis major myofascial flap
• salvage total laryngectomy
• chemoradiotherapy

Acknowledgments

The authors would like to thank Dr. Irene Serrano and the Department of Preventive Medicine of our institution, for their contribution to the statistical analysis.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.