Current opinions in otolaryngology and head and neck surgery: functional considerations in reconstruction after laryngectomy

Abstract

Purpose of review To review reconstruction techniques following total laryngectomy, partial laryngopharyngectomy, and total laryngopharyngectomy with an emphasis on long-term swallow and speech outcomes. Recent findings Recent literature has shown that the use of fasciocutaneous free flaps in the reconstruction of laryngectomy defects may lead to improved speech and swallow outcomes as compared with regional or free musculocutaneous flaps. Radial forearm and anterolateral thigh are the most often used fasciocutaneous free flaps, with similar speech and swallow outcomes. Primary closure with myofascial flap onlay yields similar speech and swallow results to fasciocutaneous flaps following laryngectomy that spares sufficient pharyngeal mucosa. Summary Whenever reconstructing a salvage laryngectomy defect or a primary laryngectomy defect with mucosal deficiency, current evidence suggests that a fasciocutaneous free flap used to augment pharyngeal volume both improves fistula rates as well as long-term speech and swallow outcomes. When sufficient pharyngeal mucosa is present, myofascial onlay can be considered as well.

Comparison of the outcomes of anterolateral thigh flap and peroneal flap in total laryngectomy reconstruction

“…In the reconstruction of total laryngectomy, our study found that the ALT flap was more reliable than the peroneal flap. ALT flaps have a large skin donor site, dependable perforators, and adequate volume to fill the dead space and are simple to design with a monitor flap and phonatory tube 25,29 . The multilayer fascial underlay technique can also be used to reduce the rate of fistula formation even further 30 .…”

“…If the flap volume was insufficient to fill up the space and heal with surrounding tissue, resulting in an “empty neck,” a higher risk of leakage and late fistula formation could be expected (Figure 1 ). 17 , 25 This idea could be applied to the use of an RF flap. Many studies have found a higher risk of fistula formation in the RF flap reconstruction population, 11 , 19 , 26 which could be the reason.…”

“…ALT flaps have a large skin donor site, dependable perforators, and adequate volume to fill the dead space and are simple to design with a monitor flap and phonatory tube. 25 , 29 The multilayer fascial underlay technique can also be used to reduce the rate of fistula formation even further. 30 In addition, the donor site of the ALT group usually could be closed primarily.…”

10-Year Experience with the Modified Pectoralis Major Flap: The Use of the Deltopectoral Flap to Reduce Skin Tension

“…Reconstruction of pharyngeal defects following resection of advanced laryngopharyngeal cancer remains a challenge. Many techniques have been proposed and utilised over the years with free flap reconstruction being the current mainstay of treatment providing very good functional and cosmetic outcomes even though donor site morbidity and flap failures remains an issue [11][12][13]. Pectoralis major flap reconstruction is an alternative reconstructive option of neopharynx.…”