Reconstruction of partial hypopharyngeal defects following total laryngectomy: Pectoralis major myofascial versus myocutaneous flaps

Tonsbeek, Anthony M.; Hundepool, Caroline A.; Duraku, Liron S.; Sewnaik, Aniel; Mureau, Marc A.M.

doi:10.1016/j.bjps.2023.06.050

Cited by 2 publications

(11 citation statements)

References 17 publications

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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].…”

Section: Resultsmentioning

confidence: 99%

“…and R.L.). In addition, we added our own retrospective single-center data, including all consecutive patients who underwent a pectoralis major-flap reconstruction following TLE with a partial hypopharyngectomy between 1 January 2000 and 1 April 2022, and a consecutive cohort of patients that received an RFFF reconstruction [9].…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, the occurrence of persistent fistulas requiring surgical treatment could not be determined for most studies. Fistulas-regardless of their management-were most frequently reported following PMMC flaps (n = 145/360, 40%), followed Forest plot of oral intake rates (either solid, soft or liquid diet) by flap type [5,9,[11][12][13]20,22,24,25,29,31,32].…”

Section: Fistulasmentioning

confidence: 99%

“…In contrast, PMMF flaps appear to yield promising outcomes in terms of a similar fistula rate (7%) compared with free-flap reconstructions (RFFF 17%; ALTFF 10%) and a significantly lower rate than in PMMC flap reconstructions (34%) [5,9]. The single-stage technique and idea behind a skin-lined or solely mucosal neopharyngeal wall was first proposed by Robertson and Robinson in 1985, who reported successful results in a series of seven patients, of whom only one developed a fistula that could be managed conservatively [7].…”

Section: Fistulasmentioning

confidence: 99%

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

Tonsbeek,

Leidelmeijer,

Hundepool

et al. 2024

Cancers

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Background: Various operative techniques exist to reconstruct partial hypopharyngeal defects following total laryngectomy. The current study aimed to investigate and compare complications and functional results following commonly used reconstructive techniques. Methods: A systematic review and meta-analysis were performed using studies that investigated outcomes after the reconstruction of a partial hypopharyngeal defect. The outcomes of interest were fistulas, strictures, flap failure, swallowing function and postoperative speech. Results: Of the 4035 studies identified, 23 were included in this review. Four common reconstructive techniques were reported, with a total of 794 patients: (1) pectoralis major myocutaneous and (2) myofascial flap, (3) anterolateral thigh free flap and (4) radial forearm free flap. Fistulas occurred significantly more often than pectoralis major myocutaneous flaps (34%, 95% CI 23–47%) compared with other flaps (p < 0.001). No significant differences in the rates of strictures or flap failure were observed. Pectoralis major myofascial flaps were non-inferior to free-flap reconstructions. Insufficient data were available to assess speech results between flap types. Conclusion: Pectoralis myocutaneous flaps should not be the preferred method of reconstruction for most patients, considering their significantly higher rate of fistulas. In contrast, pectoralis major myofascial flaps yield promising results compared to free-flap reconstructions, warranting further investigation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Fistulasmentioning

confidence: 99%

Section: Fistulasmentioning

confidence: 99%

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

Tonsbeek,

Leidelmeijer,

Hundepool

et al. 2024

Cancers

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Evaluating Pedicled Pectoralis Major Myocutaneous Flap Reconstructions for Oral Malignancy and the Influence of Laterally Based Rotational Advancement Flap on Donor Site Integrity and Nipple Position in Male Patients

Chaturvedi,

Kushwaha,

Jha

et al. 2024

Cureus

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Oral cancer poses a significant health burden, particularly in the male population of India. This study focuses on evaluating the outcomes of 48 pedicled Pectoralis major myocutaneous (PMMC) flap reconstructions in male patients with oral malignancy. Given the challenges associated with microvascular flap reconstructions, especially in advanced cancer cases, older patients, and resource-constrained settings, the PMMC flap still serves as a valuable alternative.The study introduces a novel approach by incorporating a laterally based rotational advancement flap (LBRA) to address donor site integrity and decrease the nipple-areolar complex (NAC) displacement. Traditionally, PMMC flap designs tend to cause inward shifting of the NAC during chest donor site closure, impacting the aesthetic outcome. Surgical techniques involved wide local resection, neck dissection, and PMMC flap reconstruction. The Flap design included a horizontal orientation with adjustments based on defect location. Additionally, a laterally based rotational flap from the chest aided in donor site closure. Results demonstrate the versatility and reliability of PMMC flap reconstructions, with no total flap necrosis or major complications observed in the 48 cases. The LBRA technique effectively mitigated NAC displacement. The study contributes to the existing literature by providing insights into the advantages of PMMC flap reconstructions and introducing a technique to optimize donor site closure and decrease the medial shifting of the nipple. The adaptability, reliable vascular supply, and simplified learning curve make the PMMC flap a preferred choice in resource-constrained settings with high patient demand.In conclusion, this research underscores the continued relevance and effectiveness of the PMMC flap in head and neck reconstruction, offering satisfactory cosmetic and functional results. The introduction of the LBRA technique adds a nuanced dimension to improve outcomes, particularly in male patients with oral malignancy.

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Reconstruction of partial hypopharyngeal defects following total laryngectomy: Pectoralis major myofascial versus myocutaneous flaps

Cited by 2 publications

References 17 publications

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

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

Evaluating Pedicled Pectoralis Major Myocutaneous Flap Reconstructions for Oral Malignancy and the Influence of Laterally Based Rotational Advancement Flap on Donor Site Integrity and Nipple Position in Male Patients

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