Repair of post-laryngectomy pharyngocutaneous fistulas using a pectoralis major flap

Abstract

The pectoralis major flap is a useful approach to repair pharyngocutaneous fistula. Placing salivary tubes during fistula repair significantly reduces hospital stay and complication severity in case of pharyngocutaneous fistula recurrence.

Manejo de fístulas faringocutáneas en pacientes operados de faringolaringectomía y reconstrucción inmediata por carcinoma de hipofaringe avanzado

“…En nuestra serie, ocho pacientes (66%) fueron reconstruidos de esta manera. [13][14][15][16] La gran versatilidad del colgajo ALT permite realizarlo en forma tubular, éste se conecta en la porción superior a la orofaringe residual y en la inferior al esófago proximal. Las fístulas Figura 4: Caso 2.…”

Low skeletal muscle mass assessed directly from the 3rd cervical vertebra can predict pharyngocutaneous fistula risk after total laryngectomy in the male population

“…When a PCF was confirmed, the initial treatment was conservative management involving antibiotic therapy, continuation of enteral nutrition, and daily local wound care. In cases that did not respond adequately to conservative management, pectoralis major flap reconstruction was considered on a case-by-case basis [ 26 ].…”

<p>Optimal Management of Post-Laryngectomy Pharyngo-Cutaneous Fistula</p>

“…36 It is otherwise suggested in case of large fistulas 20,25 or PCFs with major wound breakdown and vessel exposure. 2,13,35 Guha et al 20 , for example, suggested the use of these pedicled flaps in case of type 2 or 3 fistula (i.e. larger than 0.5 or 2 cm).…”

“…1 Several risk factors have been analyzed in order to understand the etiology of this major complication: previous radiotherapy (RT) or chemoradiotherapy (CHT), type of surgery, T and N stage, a short interval between the end of RT and laryngectomy, hemoglobin levels lower than 125 g/L preoperative as well as postoperative, comorbidities such as diabetes, liver diseases or hypothyroidism, and surgical aspects such as neck dissection, previous tracheotomy, surgical wound infection, resection of the pharynx and its closure after laryngectomy, or the use of non-irradiated tissue to reinforce the pharyngeal suture. [2][3][4][5] The treatment of PCF is crucial in patients who underwent laryngectomy; the persistence of this abnormal communication is associated with delay in adjuvant treatment, prolonged hospital stay, requirement for reoperation, and mortality from, for example, carotid blowout or aspiration pneumonia. The increased incidence of post-laryngectomy PCF in the modern era of organ preservation therapy has driven considerable efforts to develop…”

“…Fistula healing rates between 65 and 94% are commonly reported using conservative measures; in previously irradiated necks, spontaneous closure is less commonly achieved with rates as low as 33% being reported. 2 The analysis of the international literature shows a high variability of treatment approaches; there is no consensus about conservative treatment and waiting time, and neither about the indication for surgical treatment or the ideal surgical technique. In addition, the application of new therapies, such as NPWT ad HBOT is preliminary and the number of patients treated is still poor.…”