Xenogeneic acellular dermal matrix in combination with pectoralis major myocutaneous flap reconstructs hypopharynx and cervical esophagus

Abstract

The aim of this study was to explore xenogeneic acellular dermal matrix (ADM) in combination with pectoralis major myocutaneous flap in hypopharynx and cervical esophagus reconstruction. A total of five patients were treated with this surgical method to reconstruct hypopharynx and cervical esophagus in Second Xiangya Hospital between January 2012 and April 2013. Four of them had hypopharyngeal carcinoma with laryngeal and cervical esophageal invasion, while the fifth patient with hypopharyngeal cancer had developed scars and atresia after postoperative radiotherapy. The defect length after hypopharyngeal and cervical esophageal resection was 6-8 cm, and was repaired by a combination of ADM and pectoralis major myocutaneous flap by our team. Interestingly, the four patients had primary healing and regained their eating function about 2-3 weeks after surgery, the fifth individual suffered from pharyngeal fistula, but recovered after dressing change about 2 months. Postoperative esophageal barium meals revealed that the pharynx and esophagus were unobstructed in all five patients. Xenogeneic ADM in combination with pectoralis major myocutaneous flap for hypopharynx and cervical esophagus reconstruction is a simple, safe and effective method with fewer complications. Nevertheless, according to the defect length of the cervical esophagus, the patients need to strictly follow the medical advice.

Application of xenogenic acellular dermal matrix in reconstruction of oncological hypopharyngeal defects

“…3 Electronic laryngoscopic examination of one patient 2 months after surgery, the draft was covered by mucosal like tissue (white arrow) Eur Arch Otorhinolaryngol incidence of pharyngeal fistula ranged from 16.2 to 40 % in flap based reconstruction surgery. Old age, poor tolerance to major operation and severe nutritional deficiencies were ascribed [3,8,15]. The incidence rate of pharyngeal fistula in this study is less than the reported, which would attribute to short operation time, less intraoperative bleeding, proper antibiotic therapy,enteral nutrition and excellent blood circulation derived from thyroid gland.…”

“…It is widely accepted in the clinic due to its similar biological properties to those of ADM. Its low price and wide variety of sources meet the clinical needs much better. Yin reported reconstruction of hypopharynx and cervical esophagus using xeno-ADM combination with pectoralis major myocutaneous flap in five patients [8]. Here we report our experience of using xeno-ADM alone in hypopharyngeal reconstruction from 2011 to 2012.…”

Use of acellular dermal matrices in laryngotracheal and pharyngeal reconstruction: systematic review

“…A total of 11 articles and 170 cases were included in this review (Table I). 14 – 24 There were seven case series, 16 – 19 , 21 – 23 three case reports 14 , 15 , 24 and one prospective study 20 included in the analysis, with an aggregate level of evidence of 4 based on the Oxford Center for Evidence-Based Medicine. The sole prospective study included was performed with the financial support of the acellular dermal matrix manufacturer 20 .…”

“…Of the 11 studies included, 7 detailed the use of AlloDerm, 14 – 20 3 described the use of Heal-All Oral Biofilm (Zhenghai Biotech, Yantai, China) 21 – 23 and 1 study outlined the use of Permacol (Covidien, Dublin, Ireland) 24 . AlloDerm is an acellular dermis derived from human cadaveric tissue, and is available in freeze-dried or ready-to-use forms.…”

Traumatic laryngotracheal stenosis treated by hyoid–sternohyoid osseomuscular flap combined with xenogenic acellular dermal matrix: A case report and literature review

“…ADM is a biological material that has been mainly used to repair small defects in otorhinolaryngology-head and neck surgery, such as nasal septal mucosal defects, 12 anterior skull base defects, 13 tympanoplasty, 14 and reconstruction of defects from head and neck tumors. 11 , 15 - 17 Li et al. 11 recently reported that xenogenic ADM was successfully used to repair defects after resection of half of the tracheal circumference in two patients with tracheal adenoid cystic carcinoma.…”