Laringectomia de resgate: utilização do retalho miocutâneo de peitoral maior na prevenção de fístula faringocutânea

Sousa, Alexandre Andrade; Castro, Sebastião Maurício de Oliveira; Porcaro-Salles, José Maria; Soares, João Marcos Arantes; Moraes, Gustavo Meyer de; Carvalho, Jomar Rezende; Silva, Guilherme Souza

doi:10.1590/s1808-86942012000400019

Cited by 28 publications

(7 citation statements)

References 20 publications

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“…In total, 23 eligible studies for partial hypopharyngeal defects following TLE were selected for inclusion. The included studies reported data on complications and functional outcomes after PMMC flap (n = 13) [9,[11][12][13][14][15][16][17][18][19][20][21][22], pectoralis major myofascial flap (PMMF flap, n = 2) [5,9], RFFF (n = 5) [23][24][25][26] and ALTFF (n = 7) [22,[26][27][28][29][30][31][32] reconstructions. The numbers of patients included in each reconstructive group were the following: 394 (PMMC flap), 57 (PMMF flap), 160 (RFFF) and 183 (ALTFF), with a total of 794 patients.…”

Section: Resultsmentioning

confidence: 99%

“…Funnel plots of the primary outcome measures are shown in Figure A1 (online supplement), showing considerable asymmetry for studies reporting on fistula and stricture rates, indicating a high heterogeneity and the risk of publication bias. [5,9,11,12,[14][15][16][17][18][19][20][21][23][24][25][26]28,29,31,32].…”

Section: Resultsmentioning

confidence: 99%

“…Figure 3. Forest plot of unspecified fistula rates by flap type[5,9,11,12,[14][15][16][17][18][19][20][21][23][24][25][26]28,29,31,32].…”

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confidence: 99%

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Reconstruction of Partial Hypopharyngeal Defects following Total Laryngectomy: A Systematic Review and Meta-Analysis

Tonsbeek,

Leidelmeijer,

Hundepool

et al. 2024

Cancers

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Background: Various operative techniques exist to reconstruct partial hypopharyngeal defects following total laryngectomy. The current study aimed to investigate and compare complications and functional results following commonly used reconstructive techniques. Methods: A systematic review and meta-analysis were performed using studies that investigated outcomes after the reconstruction of a partial hypopharyngeal defect. The outcomes of interest were fistulas, strictures, flap failure, swallowing function and postoperative speech. Results: Of the 4035 studies identified, 23 were included in this review. Four common reconstructive techniques were reported, with a total of 794 patients: (1) pectoralis major myocutaneous and (2) myofascial flap, (3) anterolateral thigh free flap and (4) radial forearm free flap. Fistulas occurred significantly more often than pectoralis major myocutaneous flaps (34%, 95% CI 23–47%) compared with other flaps (p < 0.001). No significant differences in the rates of strictures or flap failure were observed. Pectoralis major myofascial flaps were non-inferior to free-flap reconstructions. Insufficient data were available to assess speech results between flap types. Conclusion: Pectoralis myocutaneous flaps should not be the preferred method of reconstruction for most patients, considering their significantly higher rate of fistulas. In contrast, pectoralis major myofascial flaps yield promising results compared to free-flap reconstructions, warranting further investigation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Reconstruction of Partial Hypopharyngeal Defects following Total Laryngectomy: A Systematic Review and Meta-Analysis

Tonsbeek,

Leidelmeijer,

Hundepool

et al. 2024

Cancers

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“…El cierre espontáneo ocurre en la mayoría de los casos de FFC, no así en los faringostomas que requieren reparación quirúrgica (2,9,18,37). Estas cirugías son consideradas contaminadas debido a que la saliva es un caldo de cultivo para el desarrollo bacteriano (22,25).…”

Section: Discusionunclassified

Use of the sternocleidomastoid muscle collar flap in the surgical treatment of the pharyngostoma. Case report and literature review

Ruíz

Osorio

Persano

et al. 2017

An. Fac. Cienc. Méd. (Asunción)

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REPORTE DE CASOUtilización del colgajo muscular en collar del esternocleidomastoideo en el tratamiento quirúrgico del faringostoma. Presentación de un caso y revisión de la literatura Use of the sternocleidomastoid muscle collar flap in the surgical treatment of the pharyngostoma. Case report and literature review RESUMENLa fístula faringocutánea se define como una dehiscencia del cierre de la mucosa faríngea, que produce fuga de saliva y comunicación de la luz faríngea con la piel. Puede clasificarse en fístula propiamente dicha, en el que un trayecto fistuloso comunica luz del tubo digestivo con el exterior y en faringostoma en el que la luz de la faringe se abre directamente al exterior con pérdida importante de tejidos blandos. Es una complicación frecuente tras cirugías abiertas de laringe, pudiendo también aparecer tras cirugías de faringe, de columna espinal, reconstrucciones mandibulares así como en cirugías del piso de boca.Si bien pueden cerrar espontáneamente o con tratamiento conservador, muchas de ellas, sobre todo cuando existe una comunicación amplia entre la faringe y la piel, requieren de cirugía. Existen varias técnicas quirúrgicas para cerrar dichas fístulas. Se presenta un caso en el que se realizó la excéresis de un tumor de base de lengua sangrante, incontrolable, con una faringotomía suprahioidea como vía de abordaje, que presentó como complicación postoperatoria una fístula faringocutánea seguida de la formación de un faringostoma amplio. Fue tratado quirúrgicamente con una síntesis del defecto y refuerzo con colgajo muscular en collar con el fascículo esternal bilateral de esternocleidomastoideo. El paciente presentó buena evolución con cierre de la fístula.Palabras Clave: fistula faringocutánea -faringostoma -cierre -colgajo -esternocleidomastoideo. ABSTRACTPharyngocutaneous fistula is defined as a dehiscence of the closing of the pharyngeal mucosa, which produces leakage of saliva and communication of pharyngeal light with the skin. It can be classified as a fistula proper, in which a fistulous tract communicates light from the digestive tract with the outside and in a pharyngostoma in which the pharyngeal lumen opens directly to the outside with significant loss of soft tissues. It is a frequent complication after open surgeries of the larynx, and may also appear after surgery of the pharynx, spinal column, mandibular reconstructions as well as surgeries of the floor of the mouth. Although they can close spontaneously or with conservative treatment, many of them, especially when there is a wide communication between the pharynx and the skin, require surgery. There are several surgical techniques to close these fistulas. We present a case in which the excresis of a tongue-based tumor was performed, due to uncontrollable bleeding, with a suprahyoid pharyngotomy as the approach, presenting as a postoperative complication a pharyngocutaneous fistula followed by the formation of a broad pharyngostoma. He was treated surgically with a synthesis of the defect and reinforcement with a muscular...

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“…Pharyngocutaneous fistula (PCF) is more often seen in salvage laryngectomy than with primary laryngectomy due to radiation damage to the microvascular structure, causing delayed wound healing [5,6]. Several different types of techniques and methods have been used to prevent PCF such as pectoralis major myocutaneous (PMMC) flap and pedicle free flaps [7,8].…”

Section: Introductionmentioning

confidence: 99%

Role of Pectoralis Major Myocutaneous Flap in Laryngectomy Surgery: Single Surgeon Experience

Bathula

Stern

Ross

et al. 2021

Cureus

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Laringectomia de resgate: utilização do retalho miocutâneo de peitoral maior na prevenção de fístula faringocutânea

Cited by 28 publications

References 20 publications

Reconstruction of Partial Hypopharyngeal Defects following Total Laryngectomy: A Systematic Review and Meta-Analysis

Reconstruction of Partial Hypopharyngeal Defects following Total Laryngectomy: A Systematic Review and Meta-Analysis

Use of the sternocleidomastoid muscle collar flap in the surgical treatment of the pharyngostoma. Case report and literature review

Role of Pectoralis Major Myocutaneous Flap in Laryngectomy Surgery: Single Surgeon Experience

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