Optimal Management of Post-Laryngectomy Pharyngo-Cutaneous Fistula

Figures & data

Table 1 Main Features of the 35 Selected Articles

	Authors	Type of Article	No. of Patients	Mean Age	Primary Treatment	Previous Treatment	1° Treatment Fistula	Analysed Treatment	Type of Surgery	Flap	% Closure
1	Abt et al 2017^Citation10	Case report	1	65	STL + RT + CT	RT	Surgery + HBOT	Surgery	Pedicled flap	TPFF	100%
2	Abu Eta et al 2016^Citation8	Retrospective	8	62.3	PTL+ RT + CT	–	–	HBOT	–	–	87.5 %
3	Bohannon et al 2011^Citation11	Retrospective	20	61.9	STL	CRT	–	Surgery	Free and pedicled flap	RFFF (19) Rectus (2) ALT(1) PMF (1)	85%
4	Busoni et al 2015^Citation12	Retrospective	86	–	PTL STL	None RT (44%) CRT (20%)	Conservative (62.8%)	Surgery (32) HBOT (15)	Pedicled flap	PMMC or myofascial	100%
5	De Zinis et al 1999^Citation13	Retrospective	40	–	PTL STL	RT	Conservative (70%)	Surgery	Direct closure (10), pedicled flap	DP (1) PMMC (1)	83%
6	Dedivitis et al 2007^Citation14	Retrospective	7	59.7	PTL STL	None RT (25%)	Conservative (71%)	Surgery	Pedicled Flap	DP	100%
7	Demir et al 2006^Citation15	Retrospective	9	65	STL	RT	Primary closure	Surgery	Pedicled flap	Submental Artery Island Flap	100%
8	Fabrizio et al 2000^Citation16	Case report	1	84	STL	RT	Local flap (mucosal lingual) + HBOT	Surgery	Pedicled flap	TPFF	100%
9	Fink et al 2015^Citation17	Case report	5	65.8	STL	RT (60%) CRT (40%)	HBOT (1)	Surgery	Endoscopic	–	100%
10	Galli et al 2005^Citation18	Retrospective	43	64	PTL STL	None RT (41,8%)	Conservative (65%)	Surgery	Direct closure	–	100%
11	Guha et al 2007^Citation19	Retrospective	5	59.8	STL	RT	Conservative (6 weeks)	Surgery	Direct closure (1) Pedicled flap (4)	DP (2) PMMC (1) DP + PMMC (1)	100%
12	Hamahata et al 2014^Citation20	Short Communication	25	70.3	PTL STL	None RT (80%)	–	Surgery	Pedicled flap	PMMC (14) PMMC “frilled” (11)	86% 100%
13	Hirano et al 2015^Citation21	Case report	1	52	STL	CRT	Conservative + Direct closure	Surgery	Free + pedicled flap	Jejunal flap + DP	100%
14	Huang et al 2018^Citation22	Retrospective	8	57.6	STL	RT (75%) CRT (25%)	Conservative + NPWT	Surgery	Pedicled	Lower TIMF	100%
15	Iteld et al 2007^Citation23	Retrospective	9	55	PTL STL	None (11%) RT (67%) CRT (22%)	Conservative + HBOT	Surgery	Free flap	ALT	100%
16	Jakubowicz et al 2005^Citation24	Case report	2	58.5	PTL(1) STL(1)	None CRT	Conservative + PMF (1) Conservative	Recombinant platelet-derived growth factor-BB Becaplermin	–	–	100%
17	Kakabadze et al 2016^Citation25	Retrospective	8	–	STL	CRT	–	DLHACM (mean time 18 d)	–	–	100%
18	Karakullukcu et al 2010^Citation26	Case report	1	61	STL + TEP	CRT	Conservative + PMF	Surgery	Voice prothesis	–	100%
19	Kilic et al 2015^Citation27	Retrospective	32	61.4	PTL STL	None RT (34,4%)	Conservative (68%)	Surgery	Local (4) Pedicled (6)	Single lobed flap SCM Flap PMMC	100%
20	Loeck et al 2019^Citation28	Case report	1	66	PTL	None	Conservative	ENPT (14 days)	–	–	100%
21	Makitie et al 2006^Citation29	Retrospective	21	62	PTL STL	None RT (19%)	Conservative (85,7%)	Surgery	Free flap, pedicle flap	PMMC (2), latissimus dorsi (1)	100%
22	McLean et al 2012^Citation30	Retrospective	47	–	PTL STL	None RT (34,9%)	Conservative (48,9%)	Surgery	Direct closure, pedicled, free flap	PMMC, jejunal flap	95,7%
23	Neubauer et al 2014^Citation31	Case report	2	77.5	STL	OPHL 1+ RT(1) RT(1)	Conservative	Surgery	Pedicled flap	Platysma myocutaneous flap	100%
24	Pabiszczak et al 2015^Citation32	Retrospective	6	–	STL	CRT	–	Surgery	Pedicled flap	Supraclavicular flap	84%
25	Pantvaidya et al 2017^Citation33	Retrospective	38	–	PTL STL	None RT (42,1%)	Conservative (58%)	Surgery	–	–	–
26	Pirgousis et al 2011^Citation34	Case report	2	56	PTL STL	RT CRT	Multiple surgery	Surgery	Pedicled flap	IMAP Flap	100%
27	Raman et al 2005^Citation35	Case report	1	–	PTL	–	–	Surgery	Pedicled	SCM flap	100%
28	Saki et al 2008^Citation36	Retrospective	19	54.2	STL PTL	RT	Conservative (89,5%)	Surgery	Direct closure, pedicled flap	PMMC (1)	100%
29	Sumarroca et al 2018^Citation2	Retrospective	50	61.4	PTL STL	None RT(11)	Conservative, pedicled flap IMAP (2)	Surgery	Pedicled flap	PMMC (12), myofascial (38)	56%
30	Teixeira et al 2017^Citation37	Case report	2	64	PTL STL	None OPHL + RT	–	NPWT (21,5 days)	–	–
31	Virtaniemi et al 2001^Citation4	Retrospective	20	–	PTL PTL + RT STL	−RT	Conservative (80%)	Surgery	–	–	95%
32	Walton et al 2014^Citation38	Retrospective	29	57	PTL PTL + RT PTL + CRT STL	—CRT	Conservative (89,7%)	Surgery	Direct closure, pedicled flap	PMF	100%
33	Wiseman et al 2002^Citation39	Case report	1	68	STL	RT	Conservative	Surgery	Direct closure + fibrin glue	–	100%
34	Yoo Min et al 2006^Citation40	Case report	2	46	STL	RT	Conservative	Surgery	Free flap	RFFF	100%
35	Zhang et al 2016^Citation41	Case report	1	56	PTL + RT	CT	Conservative + multiple surgery	NPWT (60 days)	–	–

Abbreviations: RT, radiotherapy; CT, chemotherapy; CRT, chemoradiotherapy; PTL, primary total laryngectomy; STL, salvage total laryngectomy; HBOT, Hyperbaric oxygen therapy; NPWT, negative-pressure wound therapy; ENPT, endoscopic negative-pressure therapy; PMF, pectoralis major flap; PMMC, pectoralis major musculocutaneous; IMAP, Internal mammary artery perforator; TIMF, Trapezius island myocutaneous flap; DP, deltopectoral; SCM, sternocleidomastoid; TPFF, temporoparietal fascia flap; RFFF, radial forearm free flap; ALT, anterolateral thigh.

Figure 1 Studies identification and selection process.

Figure 2 Flow chart of the suggested surgical treatments according to PCF size.

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