Free Flap Inset Techniques in Salvage Laryngopharyngectomy Repair: Impact on Fistula Formation and Function

• Published in: The Laryngoscope Vol. 131; no. 3; p. E875
• Main Authors: Chen, Diane W, Ellis, Mark A, Horwich, Peter, Sandulache, Vlad C, Liou, Nelson E, Hernandez, David J, Sturgis, Erich M, Graboyes, Evan M, Hornig, Joshua D, Day, Terry A, Huang, Andrew T
• Format: Journal Article
• Language: English
• Published: United States 01.03.2021
• Subjects: Aged; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Cutaneous Fistula - epidemiology; Cutaneous Fistula - prevention & control; Female; Free Tissue Flaps; Humans; Laryngeal Neoplasms - pathology; Laryngeal Neoplasms - surgery; Laryngectomy - adverse effects; Male; Middle Aged; Pharyngeal Diseases - epidemiology; Pharyngeal Diseases - prevention & control; Pharyngectomy - adverse effects; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Reconstructive Surgical Procedures; Retrospective Studies; Treatment Outcome; microvascular reconstruction; free flap; gastrostomy tube; fistula; Laryngectomy; TEP
• ISSN: 1531-4995
• DOI: 10.1002/lary.28939

To characterize pharyngocutaneous fistula (PCF) rates and functional outcomes following microvascular free tissue transfer (MVFTT) reconstruction of salvage total laryngectomy (STL) with a review of two different flap inset techniques and a review of the literature. Retrospective review. Review of the literature revealed 887 patients who underwent STL MVFTT from 14 references. Ninety-six STL MVFTTs were performed by the authors, with 36 (38%) patients undergoing multilayer fascial underlay (MLFU) closure and 60 (62%) a standard single layer closure (SLC). One (3%) PCF occurred in the MLFU group compared to 12 (20%) in the SLC cohort (P = .03). Postoperative gastrostomy (G)-tube dependence was lower following MLFU closure compared to SLC (25% vs. 57%, P < .01), whereas pharyngoesophageal stricture (PES) (28% vs. 38%), tracheoesophageal puncture (TEP) placement (42% vs. 42%), and TEP usage (87% vs. 88%) did not significantly differ (P > .05). Compared to pooled rates from the literature, patients who underwent a MLFU MVFTT inset technique demonstrated significantly lower PCF incidence (3% vs. 23%, P < .01) without significant differences in PES (28% vs 23%, P = .55), G-tube dependence (25% vs. 23%, P = .25), or TEP placement (42% vs. 59%, P = .09). Despite MVFTT reconstruction after STL, G-tube dependence, PCF formation, and limitations of speaking rehabilitation (TEP) remain a significant issue. Modification of MVFTT inset may provide an opportunity to reduce PCF incidence without affecting other functional outcomes. 4 Laryngoscope, 131:E875-E881, 2021.