Stomal recurrence: Salvage surgery and reconstruction utilizing microvascular free tissue transfer

Pittman, Amy; Lindau, Robert; Andersen, Peter E.; Wax, Mark K.

doi:10.1002/hed.23468

Cited by 8 publications

(10 citation statements)

References 12 publications

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“…Only a few cases using free radial forearm and anterolateral thigh flaps have been reported. 1,9 To our knowledge, one-stage pharyngoesophageal and anterior mediastinal tracheostomy reconstruction with a single skin flap has not been reported to date, and this is the first study to use a chimeric-designed anterolateral thigh flap. However, our method is only feasible when the anterolateral thigh flap has multiple cutaneous perforators that allow for splitting of the skin flap into two skin paddles.…”

Section: Discussionmentioning

confidence: 97%

Chimeric Anterolateral Thigh Flap for One-stage Reconstruction after Cervical Exenteration with Anterior Mediastinal Tracheostomy

Liu

Hung

Tseng

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Summary: Cervical exenteration with anterior mediastinal tracheostomy is rarely performed for extensive cervicothoracic malignancies. Although it provides effective palliation and occasional cure, reconstruction remains a formidable challenge owing to its complexity and high mortality. The resultant defects usually require an intestinal flap or tubed skin flap to restore the alimentary tract, soft-tissue interposition to separate the relocated trachea from the innominate artery, and another tubed or fenestrated skin flap to create a tension-free tracheocutaneous anastomosis and provide coverage for the exposed vessels, hopefully in one stage. We report a case involving a 60-year-old woman with recurrent medullary thyroid cancer who developed dyspnea and dysphagia. Salvage cervical exenteration and anterior mediastinal tracheostomy were complicated by tissue fibrosis caused by previous surgical and radiation therapies, resulting in complex defects with segmental loss of the esophagus, a short stump of trachea incapable of tracheocutaneous anastomosis, and great-vessel exposure. We used a chimeric anterolateral thigh flap consisting of a tubed skin flap for pharyngoesophageal reconstruction, a fenestrated skin flap for tracheostomy and neck coverage, and a vastus lateralis muscle bulk to separate the innominate artery from the relocated trachea. To our knowledge, this is the first report describing the reconstruction of such a complex defect with a single skin flap in a single stage.

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Section: Discussionmentioning

confidence: 97%

Chimeric Anterolateral Thigh Flap for One-stage Reconstruction after Cervical Exenteration with Anterior Mediastinal Tracheostomy

Liu

Hung

Tseng

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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“…One year survival was 40% in both groups, and only three out of eight patients with PSR Stage I–II had survivals longer than 2 years, whereas none of Sisson Stage III–IV reached such a survival time point. Sixty per cent of patients with Sisson Stage III–IV disease experienced local recurrence and eventually died [5]. Although major improvements in surgery have been applied to AMT, it has been reported that survival has not increased [5,38].…”

Section: Discussionmentioning

confidence: 99%

Peristomal recurrence following primary total laryngectomy: the enigma of the central compartment neck lymph nodes

Bradley¹

2022

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of reviewThe practice of primary total laryngectomy (TL) for advanced laryngo-hypopharyngeal cancer has significantly declined in the developed countries. The treatment options most frequently adopted have changed from open surgery to transoral laser or robotic approaches or nonsurgical (bio-chemo-) radiotherapy. Primary TL remains the treatment of choice in the developing world where healthcare resources are limited, especially for the treatment of cancer. Recent findingsPeristomal recurrence (PSR) is quite a serious complication, with an incidence of 6.6% from the published literature (mainly concerning the developed world), most diagnosed within 2 years, and associated with >80% mortality. The major risk factors include pretreatment tracheostomy, specific primary tumor subsites, positive surgical margins, and presence of nodal metastasis. The treatment options are limited and most success has been observed with surgery, especially when PSR is diagnosed at an early-stage, which is uncommon. Treatment of advanced-stage disease is usually palliative. Reduction and/or prevention of the known risk factors for PSR remain the goal when performing TL. In particular, central compartment (paraand pretracheal) lymph nodes dissection in case of large tumors with extra-laryngeal and/or subglottic extension or pretreatment tracheotomy plays a paramount role in PSR prevention. SummaryResearch is required to conclude the formulation of guidelines for proper dissection of the central compartment (level VI) lymph nodes as indicated either prophylactically or therapeutically during TL for preventing PSR.

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“…The management of airway obstruction in patients with laryngeal cancer who have not received definitive treatment is controversial [ 18 ] and there are three options to achieve an adequate airway; emergency tracheostomy, laser debulking, and emergency laryngectomy [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although an emergency tracheostomy allows a biopsy and could contribute to improve the patient nutritional status before the definitive surgery, it has been reported that it constitutes a major risk factor for peristomal recurrence which presents an incidence of 5%–15% after total laryngectomy because the tumor cells may exfoliate and survive in the peristomal granulation tissue [ 18 , 19 ], and performing the laryngectomy through a previously contaminated field may increase the risk of wound infection and make difficult the construction of a definitive tracheostomy [ 19 ]. In addition, in comparison with an elective tracheostomy, the decannulation rate is lower [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Laryngeal chondrosarcoma, case report and literature review

Hernández-Brito

Salazar-Álvarez

Álvarez-Bojórquez

et al. 2018

International Journal of Surgery Case Reports

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Stomal recurrence: Salvage surgery and reconstruction utilizing microvascular free tissue transfer

Abstract: Salvage surgery using free flap reconstruction did not show improved survival rates compared with previously described techniques.

Cited by 8 publications

References 12 publications

Chimeric Anterolateral Thigh Flap for One-stage Reconstruction after Cervical Exenteration with Anterior Mediastinal Tracheostomy

Chimeric Anterolateral Thigh Flap for One-stage Reconstruction after Cervical Exenteration with Anterior Mediastinal Tracheostomy

Peristomal recurrence following primary total laryngectomy: the enigma of the central compartment neck lymph nodes

Laryngeal chondrosarcoma, case report and literature review

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