Prophylactic pectoralis major muscle flap in prevention of pharyngocutaneous fistula in total laryngectomy after radiotherapy

Abstract

Nonirradiated tissue coverage should be routine in total laryngectomy after RT. PMMF is a good adjunct to prevent pharyngocutaneous fistula.

The infraclavicular pedicled flap in head and neck reconstruction: applications and outcomes

“…11 In comparison to the deltopectoral flap, two studies conducted in 2006 on 34 and 25 patients reported 21% and 40% complication rates, respectively, 12,13 Pharyngocutaneous fistulae occurred in three of 15 patients (20.0%) in our study when the flap was used for closure of a postlaryngectomy defect. 17 On the other hand, the retrospective study cited above revealed no difference in fistula rates between muscle flaps and fasciocutaneous flaps. According to a large multicenter retrospective study published in 2018 by the microvascular committee of the American Academy of Otolaryngology-Head and Neck Surgery, 14 fistula rates for salvage laryngectomy range from 22% to 39%, all types of reconstruction combined.…”

Efficacy of pectoralis major muscle flap for pharyngocutaneous fistula prevention in salvage total laryngectomy: A systematic review

“…After evaluating their titles and abstracts, 298 studies were excluded because they clearly did not fill the inclusion criteria. Sixteen articles potentially fit for inclusion in the review were selected . Of these, 4 were excluded after a complete reading: the first was excluded because it did not provide data regarding the incidence of pharyngocutaneous fistula separately between the groups submitted to primary and salvage laryngectomy; the second article referred to the surgical technique description, with no comparative data; the third article presented a case series of patients already mentioned in another study included in this review; in the fourth article, various types of surgical flaps were used precluding the use of data on the PMMF .…”

“…Of these, 4 were excluded after a complete reading: the first was excluded because it did not provide data regarding the incidence of pharyngocutaneous fistula separately between the groups submitted to primary and salvage laryngectomy; the second article referred to the surgical technique description, with no comparative data; the third article presented a case series of patients already mentioned in another study included in this review; in the fourth article, various types of surgical flaps were used precluding the use of data on the PMMF . Thus, this review included data from 12 observational retrospective studies, including 742 patients (253 in the PMMF group and 489 in the control group; Figure ).…”

“…Primary studies that analyzed the management of pharyngocutaneous fistula showed that patients who underwent PMMF had a lower risk of new surgical intervention compared to the control group ( p = .008).…”

The Pectoralis Major Musculocutaneous Flap in Head and Neck Cancer Reconstruction

“…The PMMF has been the workhorse flap for this indication. While some studies show a clear reduction in pharyngocutaneous fistula rates, others suggest that the fistulae that occur are smaller and rarely need repair [13][14][15][16].…”