Evaluation of Cases who Underwent Reconstruction Through Pectoralis Major Myocutaneous Flap After Laryngopharyngectomy

Abstract

Objective: In this retrospective study, we discussed the results of patients who underwent hypopharynx reconstruction through a pectoralis major myocutaneous flap (PMMF) after laryngopharyngectomy. Methods:Twenty-three patients who underwent total laryngectomy, subtotal pharyngectomy, and/ or esophagus upper segment resection due to advanced-stage (T3 and T4) laryngeal, hypopharyngeal, and esophagus upper segment-located squamous cell carcinoma and subsequent reconstruction with PMMF were retrospectively evaluated. While the minor complications were determined to be wound site infection, hemorrhage, and disruption of suture at the donor site, major complications were determined to be anastomotic line disruption, fistula, and dysphagia.Results: Eighteen (78.2%) patients were male and five (21.7%) were female; their ages varied between 33 and 72 years (mean: 60.1). According to lesion localization, 11 patients were evaluated as having laryngeal cancer, seven as having hypopharyngeal cancer, and five as having esophagus upper segment-located cancer. The rate of minor complications was 30.4%: fistula was observed in 11 (47.8%) patients and 13 (56.5%) patients mentioned difficulty swallowing only solid foods. The total follow-up period ranged from 4 to 60 (mean: 31.6) months. Conclusion:PMMF is continuing to be a good alternative reconstruction method for the reconstruction of partial hypopharyngeal defects because it is easily obtainable, one surgical team is sufficient when using the flap, and it is associated with low morbidity and mortality rates.

Reconstruction of Partial Hypopharyngeal Defects following Total Laryngectomy: A Systematic Review and Meta-Analysis

“…In total, 23 eligible studies for partial hypopharyngeal defects following TLE were selected for inclusion. The included studies reported data on complications and functional outcomes after PMMC flap (n = 13) [9,[11][12][13][14][15][16][17][18][19][20][21][22], pectoralis major myofascial flap (PMMF flap, n = 2) [5,9], RFFF (n = 5) [23][24][25][26] and ALTFF (n = 7) [22,[26][27][28][29][30][31][32] reconstructions. The numbers of patients included in each reconstructive group were the following: 394 (PMMC flap), 57 (PMMF flap), 160 (RFFF) and 183 (ALTFF), with a total of 794 patients.…”

“…Funnel plots of the primary outcome measures are shown in Figure A1 (online supplement), showing considerable asymmetry for studies reporting on fistula and stricture rates, indicating a high heterogeneity and the risk of publication bias. [5,9,11,12,[14][15][16][17][18][19][20][21][23][24][25][26]28,29,31,32].…”

Complications of pectoralis major myo‐cutaneous flap, anterolateral thigh flap and radial forearm free flap after total laryngectomy with partial pharyngectomy: A systematic review and network meta‐analysis

“…After title/abstract screening, 111 articles were selected for full text assessment. Through the application of the defined inclusion and exclusion criteria, 13 studies were included in the qualitative and quantitative analysis (Balasubramanian et al, 2018; Ho et al, 2012; Hong et al, 2009; Kim & Kim, 2013; López et al, 2013; Ooi et al, 2017; Somuk et al, 2016; Song et al, 2011; Spriano et al, 2002; Spyropoulou et al, 2011; Su & Chiang, 1995; Tan et al, 2011; Yu et al, 2010). The reasons behind the exclusion of 98 studies are shown in Figure 1.…”

Hypopharyngeal reconstruction using prelaminated autologous bio-engineered pectoralis major flaps

“…Использование выращенного из кожи пациента эпителиального пласта вместо полнослойного аутодермолоскута позволяет избежать таких осложнений, как врастание волос в просвет гортани, стенозирование просвета верхних пищеварительных путей в послеоперационном периоде. Осложнения в виде свищей, наблюдаемые у пациентов в нашем исследовании, составляют 44%, что сопоставимо с известной из литературных данных частотой свищей у пациентов, получивших предоперационное облучение, которое колеблется от 13 до 50% [17]. У 56,5% пациентов после реконструктивных операций с использованием кожно-мышечных лоскутов описывают затруднение глотания твердой пищи, а у 21,7% -трудности при глотании как твердой, так и жидкой пищи [17].…”

“…Осложнения в виде свищей, наблюдаемые у пациентов в нашем исследовании, составляют 44%, что сопоставимо с известной из литературных данных частотой свищей у пациентов, получивших предоперационное облучение, которое колеблется от 13 до 50% [17]. У 56,5% пациентов после реконструктивных операций с использованием кожно-мышечных лоскутов описывают затруднение глотания твердой пищи, а у 21,7% -трудности при глотании как твердой, так и жидкой пищи [17]. В нашем исследовании у 1 (11%) больного был стеноз глотки, который после проведения бужирования стал причиной проблем с глотанием только твердой пищи.…”