Pectoralis Major Myocutaneous Flap in Reconstruction after Salvage Laryngectomy

Abdelghany, Mahmoud Mohammed; Amine, Ayman; Bussu, Francesco; Fetohy, Tarek El-sayed; Amer, Islam; Hassan, Asem Elsani

doi:10.21608/smj.2024.319541.1494

Pectoralis Major Myocutaneous Flap in Reconstruction after Salvage Laryngectomy

Document Type : Original Article

Authors

¹ maxillofacial surgery unit, department of general, oncological and laparoscopic surgery, faculty of medecine, sohag university

² Surgery Department, National Cancer Institute (NCI), Cairo University, Kasr El-Aini Street, Fom El-Khalig, Cairo, 11796, Egypt.

³ Otolaryngology Division, Azienda Ospedaliero Universitaria, Viale San Pietro 12, 07100 Sassari, Italy

⁴ General Surgery and Maxillofacial Surgery, Sohag University

⁵ Maxillofacial Surgery Unit, Department of General Surgery, Oncological and Laparoscopic Surgery, Faculty of Medicine, Sohag University, Sohag University Street, Sohag City,Egypt

⁶ Department of General Surgery, Oncological and Laparoscopic Surgery, Faculty of Medicine, Sohag University, Sohag University Street, Sohag City, Egypt

10.21608/smj.2024.319541.1494

Abstract

Background:

Pharyngocutaneous fistula (PCF) is a major complication post salvage total laryngectomy (STL), mostly secondary to the effect of radiotherapy (RT) on tissue healing. It usually leads to other complications such as bleeding, wound infection, and wound dehiscence.

Aims/Objective:

This study aims to evaluate the outcomes of PMMF reconstruction post-STL in patients with recurrent tumours following primary treatment by CRT with a detailed analysis of all complications and causes of death.

Materials and methods:

A retrospective study involved 29 patients operated in the National Cancer Institute, Cairo, Egypt in the period between January 2015 and December 2021 by STL and reconstruction by PMMF for recurrent tumours post primary treatment by radio(chemo)therapy.

Results:

Our study included 29 patients; mean age was 54.8±10.24 years. All patients were males. All patients were operated by STL and reconstructed by PMMF, 16 (55.2%) patients complicated by pharyngocutaneous fistulae, mortality rate was high (62.1%).

Conclusion:

Recommendations for routine use of PMMF in salvage settings should be reevaluated and reconsidered. Regarding lowering the incidence of PCF, the PMMF has no objectively beneficial effect. However, it promotes faster healing of minor fistulas, and prevents larger fistula formation. Appropriate postoperative care and improvement of the nutritional state of the patient may reduce the incidence of PCF.

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