The pectoralis myofascial flap in pharyngolaryngeal surgery after radiotherapy

Righini, C.; Lequeux, Thomas; Cuisnier, O.; Morel, Nicolas; Reyt, É.

doi:10.1007/s00405-004-0827-8

Cited by 75 publications

(97 citation statements)

References 19 publications

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“…The principle behind using this so-called pectoralis major myofascial flap (PMMFF) is that healthy tissue with abundant vascularity will improve wound healing and prevent local wound complications, including PCF. Righini et al [10] reported a reduction in PCF risk after salvage surgery from 50 to 23% using PMMFF; Gil et al [11] on the other hand found no significant decrease in PCF risk using PMMFF. However, in all cases, PCF was conservatively closed.…”

Section: Discussionmentioning

confidence: 99%

Multivariate Analysis of Wound Complications after Surgery for Laryngeal and Hypopharyngeal Cancers

Sakai¹,

Okami²,

Sugimoto³

et al. 2011

ORL

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Purpose: The aim of this study was to identify the factors leading to postoperative complications following surgical management of laryngeal and hypopharyngeal cancers. Procedures: Between 2001 and 2008, the medical records of 107 laryngeal and hypopharyngeal cancer patients requiring laryngectomy or pharyngolaryngectomy at our hospital were reviewed. The incidence of wound complications and correlation of complications with clinicopathological factors were investigated by univariate and multivariate analysis. Results: The overall incidence of wound complication was 33.6%. The complication incidence was 35.2, 21.7 and 46.2% for the primary surgery, radiation and chemoradiation groups, respectively. Diabetes mellitus and bilateral paratracheal node dissection were significantly correlated and were independent risk factors according to multivariate analysis. Bleeding from a large vessel occurred in 4 patients, and there were significant correlations with chemoradiation. Conclusion: Preoperative chemoradiation was not a significant risk factor for wound complication in this study. However, once postoperative wound complications occurred, they tended to produce lethal outcomes.

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Section: Discussionmentioning

confidence: 99%

Multivariate Analysis of Wound Complications after Surgery for Laryngeal and Hypopharyngeal Cancers

Sakai¹,

Okami²,

Sugimoto³

et al. 2011

ORL

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“…Another fistula-preventive strategy is the insertion of nonirradiated, well-vascularized tissue; therefore, many authors have described the use of PM flap reconstruction in a salvage setting. Righini et al 16 performed a study examining the use of the PM flap and noted a substantial reduction in fistula rate, from 50% to 23%. This difference, however, did not reach statistical significance.…”

Section: Commentmentioning

confidence: 99%

Total Laryngectomy for a Dysfunctional Larynx After (Chemo)Radiotherapy

Theunissen¹,

Timmermans²,

Zuur³

et al. 2012

Arch Otolaryngol Head Neck Surg

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Objective: To evaluate the functional outcomes after total laryngectomy (TLE) for a dysfunctional larynx in patients with head and neck cancer that is in complete remission after (chemo)radiotherapy.Design: Retrospective cohort study.Setting: Tertiary comprehensive cancer center. Patients:The study included 25 patients from a cohort of 217 consecutive patients with TLE who were treated between January 2000 and July 2010. The inclusion criteria for this subgroup analysis were complete remission and functional problems for which TLE was considered to be the only resolution. Quality of life assessment was carried out using the European Organization for Research and Treatment of Cancer Quality of Life C30 and Head and Neck Module 35 questionnaires and an additional study-specific questionnaire covering functional aspects, such as swallowing and dyspnea, in more detail.Intervention: Total laryngectomy.Main Outcome Measures: Morbidity, mortality, and functional outcomes. Results:The indication for TLE was chronic aspiration with or without recurrent pneumonia (n = 15 [60%]), debilitating dyspnea (n = 8 [32%]), and persistent profuse hemorrhage (radiation ulcer) (n = 2 [8%]). After TLE, 14 of the 25 patients (56%) had 20 major postoperative complications, including 11 pharyngocutaneous fistulas, requiring additional treatment. Tube feeding and recurrent pneumonia incidence had decreased from 80% and 28% to 29% and 0%, respectively, 2 years after surgery. Prosthetic voice rehabilitation was possible in 19 patients (76%). Two years after surgery, 10 of 14 patients (71%) still reported TLE-related pulmonary problems despite the consistent use of a heat and moisture exchanger. The 5-year overall survival rate was 35%. Conclusions:Total laryngectomy for a dysfunctional larynx tends to have a high complication rate. However, in this study, the initial functional problems (aspiration, recurrent pneumonia, and dyspnea) did not recur. Tube feeding was significantly reduced, and the quality of life of the surviving patients appeared to be reasonable.

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“…These flaps can be quickly fashioned, are viable and reliable, versatile in reconstruction procedures, located close to the site of resection, and allow the reconstruction to be done in one single procedure with low complication rates on the donor site [18][19][20] . When used in salvage laryngectomy, the myocutaneous flap may reduce salivary fistula incidence rates from 24% to 0% (p < 0.015), as shown by Patel & Keni 8 , and from 51% to 20% (p < 0.028) according to Righini et al 21 . In our study, the incidence of salivary fistulas in myocutaneous flap patients was 16%, while primary laryngeal closure patients had a salivary fistula incidence rate of 58%.…”

Section: Discussionmentioning

confidence: 90%

“…As it is a regional flap, it does not require specific materials or teams specialized in microsurgical anastomoses; and it introduces low donor site morbidity 2,21 . Myocutaneous flaps could also reduce the risk of late complications such as stenosis, dysphagia, and use of feeding tubes as shown by Patel & Keni 8 ; these findings were not observed in our study.…”

Section: Discussionmentioning

confidence: 99%

Laringectomia de resgate: utilização do retalho miocutâneo de peitoral maior na prevenção de fístula faringocutânea

Sousa¹,

Castro²,

Porcaro-Salles³

et al. 2012

Braz. j. otorhinolaryngol.

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Salvage laryngectomy in patients treated with organ preservation protocols is associated with high rates of postoperative complications. The use of non-irradiated tissue flaps in pharyngeal reconstruction could reduce the incidence of these complications. Objective : This study aims to evaluate the usefulness of the pectoralis major myocutaneous flap in preventing salivary fistulae during the postoperative period of salvage total laryngectomy (TL). Materials and Method : This retrospective study enrolled 31 patients operated between April of 2006 and May of 2011. All patients had advanced cancer at the time of the salvage procedure and had been treated with chemoradiotherapy or radiotherapy alone. Pharyngeal reconstruction was performed using pectoralis major myocutaneous flap in 19 cases (61%); primary wound closure occurred in 12 patients (39%). Results : Salivary fistulae occurred in 16% of the patients who received the flap and in 58% of the patients with primary closure of the pharynx ( p < 0.02). No statistically significant differences were noted between the groups with respect to the mean time for fistula formation, reintroduction of an oral diet, or use of a nasoenteric tube for feeding. Conclusion : The pectoralis major myocutaneous flap was found to reduce the incidence of salivary fistulae in salvage laryngectomy procedures.

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The pectoralis myofascial flap in pharyngolaryngeal surgery after radiotherapy

Cited by 75 publications

References 19 publications

Multivariate Analysis of Wound Complications after Surgery for Laryngeal and Hypopharyngeal Cancers

Multivariate Analysis of Wound Complications after Surgery for Laryngeal and Hypopharyngeal Cancers

Total Laryngectomy for a Dysfunctional Larynx After (Chemo)Radiotherapy

Laringectomia de resgate: utilização do retalho miocutâneo de peitoral maior na prevenção de fístula faringocutânea

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