Reconstructive Options During Nonfunctional Laryngectomy

Area of Science:

• Otolaryngology
• Head and Neck Surgery
• Surgical Oncology

Background:

• Limited data exists on surgical outcomes following total laryngectomy for a dysfunctional larynx.
• Understanding closure methods is crucial for optimizing patient recovery and function.

Purpose of the Study:

• To evaluate the impact of different surgical closure methods on postoperative fistula rates and swallowing ability after total laryngectomy for a dysfunctional larynx.
• To identify optimal reconstructive techniques for improved patient outcomes.

Main Methods:

• Retrospective review of 268 patients undergoing total laryngectomy for a dysfunctional larynx post-radiation therapy (1998-2020).
• Analysis of demographic data, operative details, hospitalization length, fistula formation, fistula treatment, and 6-month enteral feeding status.
• Comparison of outcomes between primary closure and various flap methods, including radial forearm free flaps (RFFF), pectoralis flaps, and supraclavicular flaps.

Main Results:

• A total of 268 patients were analyzed; 140 (52.2%) had flap reconstruction.
• Postoperative fistulas occurred in 64 (23.9%) patients, with no significant difference between flap and primary closure (P = .06).
• Radial forearm free flaps (RFFF) demonstrated a significantly lower fistula rate (P = .02) and reduced need for long-term enteral feeding (P < .0001) compared to other methods. Pectoralis flaps required more re-operations for fistula repair.

Conclusions:

• Total laryngectomy for dysfunctional larynx results in high fistula rates (23%), but most patients (67%) do not require long-term enteral support.
• Radial forearm free flap (RFFF) reconstruction is associated with the lowest rates of postoperative fistula and enteral feeding tube dependence.
• RFFF represents an excellent option for reconstruction after total laryngectomy, improving functional outcomes.