Efficacy of the myofascial pectoralis major flap in the reduction of salivary fistulas after salvage total laryngectomy

• Published in: Acta otorrinolaringológica española (English) 2018-03, Vol.69 (2), p.99-104
• Main Authors: Chiesa Estomba, Carlos Miguel, González García, Jose Angel, Sistiaga Suarez, Jon Alexander, Thomas Arrizabalaga, Izaskun, Larruscain Sarasola, Ekhiñe, Altuna Mariezcurrena, Xabier
• Format: Article
• Language: eng ; spa
• ISSN: 2173-5735
• DOI: 10.1016/j.otorri.2017.06.003

INTRODUCTIONPharyngocutaneous fistula is the most frequent complication after total laryngectomy. Its incidence varies between 9%-25% in post primary total laryngectomy patients, to 14%-57% in salvage laryngectomy post radiotherapy or post chemotherapy + radiotherapy. The pectoralis major myofascial flap (PMMF)is postulated as a useful tool to decrease the incidence of this complication. MATERIALS AND METHODRetrospective analysis of a group of patients treated by salvage laryngectomy, associated or not with pharyngeal closure reinforcement with PMMF. RESULTSTwenty patients were included, 18 males (90%) and 2 females (10%), in 10 of whom the PMMF was used. The average age was 66.65 years. Seventeen (85%) had a laryngeal tumour and 3 (15%) had a hypopharyngeal tumour. Eight (80%) patients in the non-PMMF group had postoperative fistula, whereas only 2 (20%) patients in the PMMF group had a fistula during the postoperative period (P=.005). The mean time for fistula closure was significantly shorter in the cases where PMMF flap was used (16±11 days vs. 76.8±67 days, P=.001), as was hospital stay (19. 6±18 days vs. 83.9±77 days, P=.001). CONCLUSIONThe use of PMMF in our series is associated with a lower rate of post salvage laryngectomy fistulas in patients treated primarily by organ preservation protocol for laryngeal/hypopharyngeal cancer. In turn, it promotes local healing by decreasing the mean duration of fistula closure and the mean hospital stay.