Delayed wound infection after supracricoid partial laryngectomy following failure of high dose radiation

Abstract

Past radiation therapy is known as a major risk factor promoting post-supracricoid partial laryngectomy (SCPL) complications. Risk of post-SCPL complications may further increase following failure of high dose radiation; in these patients, wound infection may become evident more than 1 month after an uneventful post-surgical course. By defining this complication as "Delayed Wound Infection" and reviewing the clinical features, we intended to elucidate the mechanism, risk factors, and management of this post-SCPL complication. Between 1997 and 2009, 60 patients received SCPL. The incidence of post-SCPL wound infection was analyzed in reflect to radiation status, radiation dose, and medical histories. Of 60 patients, delayed wound infection was identified in 4 (7%); radiation doses were 65, 68, 70, and 76.8 Gy (avg. 70 Gy). Blood data including white blood cell and C-reactive protein showed slight elevation before the delayed infection became evident. Patients with high dose radiation (≥ 65 Gy) accompanied by histories of diabetes and renal insufficiency are considered a high risk group. Delayed re-epithelialization of the inner surface of the cricohyoido gap was presumed to be the main pathogenesis. Early initiation of antibiotics and hyperbaric oxygen therapy are effective for rapid recovery. "Delayed Wound Infection" was treatable and patients undergoing surgery after failure of high dose radiation should be managed with extra precaution, but should not be excluded from the indications for SCPL.

Salvage supracricoid laryngectomy after failed radiotherapy and partial laryngectomy

“…Therefore, when increased purulent secretion was observed, bacterial cultures and additional anti-MRSA treatment were promptly introduced. Hyperbaric oxygen therapy is also reported to facilitate wound healing 12 . Various surgical complications are reported to be associated with supracricoid laryngectomy with cricohyoidoepiglottopexy 13 .…”

“…Hyperbaric oxygen therapy is also reported to facilitate wound healing. 12 Various surgical complications are reported to be associated with supracricoid laryngectomy with cricohyoidoepiglottopexy. 13 Therefore, for successful surgery, it is important to promptly detect and correctly manage all complications.…”

The cross-plastic correction of the soft tissue defect on the neck with the use of a pectoral flap harvested from the opposite side

“…Лечение местно-распространенных, упорно рециди-вирующих опухолей покровных тканей головы представ-ляет собой очень сложную задачу, и нередко больным от-казывают в радикальном лечении после многократных безуспешных попыток хирургического и комбинирован-ного лечения [1,7,8] Приведено клиническое наблюдение пациента с метахронным первичномножественным злокачественным новообра зованием (дно полости рта слева, нижняя челюсть справа), которому произведена перекрестная пластика большого де фекта мягких тканей на шее слева кожномышечным пекторальным лоскутом с осевым кровоснабжением справа. Срок наблюдения пациента -14 лет с хорошим функциональным результатом.…”