Hinge Flap with Triangular Extension for Reconstruction of Pharyngocutaneous and Laryngocutaneous Fistulas

Azuma, Ryuichi; Aoki, Shimpo; Kuwabara, Masahiro; Aizawa, Tetsushi; Nagano, Hisato; Kiyosawa, Tomoharu

doi:10.1097/gox.0000000000001630

Cited by 5 publications

(4 citation statements)

References 17 publications

(4 reference statements)

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“…The latter occurred with an incidence of 3.4%, in agreement with other reports . While conservative medical therapy, hyperbaric oxygen, and several flaps are available to manage this type of fistula, a careful preoperative nutritional assessment and prevention with aggressive antibiotic treatment and antireflux medication may prove useful in these high‐risk patients …”

Section: Discussionsupporting

confidence: 88%

Nomograms for prediction of postoperative complications in open partial laryngeal surgery

Gallo

Locatello

Larotonda

et al. 2018

Journal of Surgical Oncology

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Background and Objectives Postoperative morbidity after open partial laryngeal surgery (OPLS) may be serious, leading to a prolonged length of hospital stay and increasing costs. We sought to define the predictive factors of complications and to develop nomograms for patients eligible for OPLS based on clinical and surgical data. Methods We critically reviewed 535 patients with laryngeal carcinoma who underwent OPLS at our Institution from 1982 to 2007. We have identified patients affected by postoperative local, airway, dysphagia, bleeding, surgical site infection, dehiscence of pexy, emphysema, and laryngocutaneous fistula complications. We have analyzed them according to age, smoking, alcohol, tumor site, clinical T and N classification, type of OPLS and neck dissection, previous treatments. Prognostic factors were considered in a multivariate logistic regression model with backward stepwise elimination and selected to construct and design nomograms for overall and specific complications. The performance was assessed using the c‐index, receiver operating characteristic, and calibration curves. Results Age, clinical T classification, type of OPLS, and alcohol were related to overall (35%) and airway complications. Nomograms were built for overall, dysphagia, and airway complications. Conclusions We have developed nomograms that can identify high‐risk patients undergoing OPLS and that can help to prevent severe complications and to tailor surgical planning.

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Section: Discussionsupporting

confidence: 88%

Nomograms for prediction of postoperative complications in open partial laryngeal surgery

Gallo

Locatello

Larotonda

et al. 2018

Journal of Surgical Oncology

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“…Triangular hinge flaps have been used in other specialties, specifically in otolaryngology, for the closure of pharyngocutaneous or laryngocutaneous fistulae 4 . The present study, also originating from the same institution, found this concept to be useful in avoiding and/or treating stomal stenosis and restenosis in buccal mucosal staged urethroplasty after the first stage 3 .…”

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confidence: 50%

Editorial Comment from Dr Martins to Triangular extension of hinge flaps: A novel technique to resolve stomal stenosis and prevent restenosis in staged buccal mucosal urethroplasty

Martins

2021

Int J of Urology

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“…The effectiveness of the TE method has also been reported in pharyngeal reconstructive surgery for stoma‐related complications of pharyngo‐cutaneous fistula; thus, we consider that this method is efficient for treating the boundary portion in procedures involving lumen construction 24 . Possible disadvantages associated with the TE method are the requirement of a relatively large graft and the complexity of suturing that might increase urine leakage and necrosis risk of the TE portion.…”

Section: Discussionmentioning

confidence: 88%

Triangular extension of hinge flaps: A novel technique to resolve stomal stenosis and prevent restenosis in staged buccal mucosal urethroplasty

et al. 2021

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Objectives To verify the utility of triangular extension of a hinge flap in buccal mucosal staged urethroplasty to resolve stomal stenosis after the first stage and ultimately prevent restenosis. Methods A total of 23 patients (triangular extension group) were studied in 2013–2019. In the first stage, buccal mucosa was transplanted, and an extended triangle portion of the mucosa was placed beside the proximal and/or distal stoma that was created when the stricture segment of the urethra was resected. In the second stage, during tubularization of the urethral plate, an incision was made at the stoma to increase the caliber to which the triangular extension was inserted. The procedure was considered successful when a 17‐Fr flexible cystoscope passed through the reconstructed urethra at 6 months after the second‐stage urethroplasty and no additional surgery or bougie dilation required. The clinical course of the triangular extension group was compared with 24 patients who underwent conventional staged urethroplasty (control group). Results In total, 20 patients from each group underwent second‐stage surgery. No patients in the triangular extension group required additional revision surgery because of stomal stenosis after first‐stage surgery, whereas five (20%) control patients did. Urethroplasty was successful in 19 patients (95%) in the triangular extension group and in 19 patients (95%) in the control group. Uroflowmetry after the second‐stage surgery indicated that the mean maximum urinary flow rate was 21.5 and 15.8 mL/s after triangular extension and the control procedure, respectively (P = 0.027). Conclusions The triangular extension technique reduces the need for revision surgery and prevents postoperative restenosis.

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Hinge Flap with Triangular Extension for Reconstruction of Pharyngocutaneous and Laryngocutaneous Fistulas

Abstract: Supplemental Digital Content is available in the text.

Cited by 5 publications

References 17 publications

Nomograms for prediction of postoperative complications in open partial laryngeal surgery

Nomograms for prediction of postoperative complications in open partial laryngeal surgery

Editorial Comment from Dr Martins to Triangular extension of hinge flaps: A novel technique to resolve stomal stenosis and prevent restenosis in staged buccal mucosal urethroplasty

Triangular extension of hinge flaps: A novel technique to resolve stomal stenosis and prevent restenosis in staged buccal mucosal urethroplasty

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