Salvage total laryngectomy: is a flap necessary?

Area of Science:

• Otolaryngology
• Surgical Oncology
• Head and Neck Surgery

Background:

• Pharyngocutaneous fistula is a major complication following salvage total laryngectomy in patients with prior radiotherapy.
• Previous radiotherapy increases the risk of fistula after laryngectomy.

Purpose of the Study:

• To review fistula rates in radiated patients undergoing salvage total laryngectomy.
• To determine if pectoralis major flap interposition reduces fistula incidence and duration.
• To examine other risk factors for fistula formation.

Main Methods:

• Retrospective review of 27 patients with larynx cancer treated between 2000 and 2017.
• Analysis of patient data, risk factors, and complications.
• Comparison between primary closure without flap and pectoralis major flap closure groups.

Main Results:

• Pharyngocutaneous fistula occurred in 55.5% of patients.
• Fistula rates were significantly higher without pectoralis major flap (78.6%) compared to with flap (30.8%).
• Pectoralis major flap use reduced fistula severity, need for surgical repair, hospital stay, and time to oral diet initiation.

Conclusions:

• Prophylactic pectoralis major flap interposition is effective in reducing fistula incidence and severity.
• The use of a pectoralis major flap should be considered in salvage total laryngectomy patients with prior radiotherapy.
• Pectoralis major flap contributes to better patient outcomes and reduced complications.