The role of pectoralis major myofascial flap in salvage laryngectomy: A single surgeon experience

Abstract

A total of 33 patients were identified, including 10 patients who underwent salvage surgery after chemoradiotherapy. In all, 80% of salvage surgery patients underwent PMMF reinforcement of the pharyngeal closure. A PCF rate of 50% was recorded for salvage surgery patients without PMMF reinforcement. Identical PCF rates (25%) were recorded for patients who underwent primary total laryngectomy and salvage surgery patients treated with PMMF reinforcement. Mean duration to fistula closure was 57.16 days in the primary laryngectomy group compared with 20.5 days in salvage surgery patients with PMMF reinforcement.

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

“…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).…”

Management of Advanced Laryngeal Cancer

“…In an effort to reduce the risk of these complications, several authors have advocated elective use of pectoralis major myogenous flaps, placed in onlay fashion, or free flaps interposed between the pharynx and skin/stoma 58. The use of a pectoralis major myogenous flap to bolster the pharyngeal repair has been reported by some authors to reduce the incidence of pharyngocutaneous fistula, and shorten time to healing in cases which do fistulize 59,60. On the other hand, other authors found no significant difference in the incidence of fistula between patients undergoing and not undergoing pectoralis major flap 45,61.…”

Acta Otorhinolaryngologica Italica

“…Therefore, in our centre, we prefer to use a pedicled myocutaneous or myofascial pectoralis major flap, which reliably provides an adequate amount of well-vascularised tissue and is particularly useful in patients who have previously undergone surgery and are candidates for adjuvant radio and/or chemotherapy 10 . Furthermore, the pectoralis major flap has been demonstrated by several reports to significantly reduce local complications such as salivary fistula 11 . In our study, the pectoralis major flap was used for reconstruction purposes in all cases.…”