Pectoralis major myofascial flap in salvage laryngectomy

Abstract

Our study demonstrated that pectoralis major myofascial flap reinforcement did not decrease the rate of pharyngocutaneous fistula formation. Instead, it prevented the formation of large fistulas that would require surgical management, and showed a similar time to oral feeding and length of hospital stay to primary laryngectomy.

Efficacy of pectoralis major muscle flap for pharyngocutaneous fistula prevention in salvage total laryngectomy: A systematic review

“…In a retrospective study of 155 total laryngectomies, the use of PMMF reinforcement did not decrease the rate of pharyngocutaneous fistula formation, but it prevented the occurrence of large fistulas that would require surgical management, showing a similar time to oral feeding and length of hospital stay to primary laryngectomy …”

“…After evaluating their titles and abstracts, 298 studies were excluded because they clearly did not fill the inclusion criteria. Sixteen articles potentially fit for inclusion in the review were selected . Of these, 4 were excluded after a complete reading: the first was excluded because it did not provide data regarding the incidence of pharyngocutaneous fistula separately between the groups submitted to primary and salvage laryngectomy; the second article referred to the surgical technique description, with no comparative data; the third article presented a case series of patients already mentioned in another study included in this review; in the fourth article, various types of surgical flaps were used precluding the use of data on the PMMF .…”

“…Of these, 4 were excluded after a complete reading: the first was excluded because it did not provide data regarding the incidence of pharyngocutaneous fistula separately between the groups submitted to primary and salvage laryngectomy; the second article referred to the surgical technique description, with no comparative data; the third article presented a case series of patients already mentioned in another study included in this review; in the fourth article, various types of surgical flaps were used precluding the use of data on the PMMF . Thus, this review included data from 12 observational retrospective studies, including 742 patients (253 in the PMMF group and 489 in the control group; Figure ).…”

“…Primary studies that analyzed the management of pharyngocutaneous fistula showed that patients who underwent PMMF had a lower risk of new surgical intervention compared to the control group ( p = .008).…”

“…The global analysis of comparisons between the groups was not changed when separating studies that included only patients who underwent total laryngectomy ( p < .001) and those who underwent total pharyngolaryngectomy ( p = .007).…”