Free Tissue Reconstruction of the Hypopharynx After Organ Preservation Therapy: Analysis of Wound Complications

• Published in: The Laryngoscope 2001-07, Vol.111 (7), p.1192-1196
• Main Authors: Teknos, Theodoros N., Myers, Larry L., Bradford, Carol R., Chepeha, Douglas B.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - radiotherapy; Carcinoma, Squamous Cell - surgery; chemotherapy; Cohort Studies; Combined Modality Therapy; Data Interpretation, Statistical; Female; Follow-Up Studies; Free tissue transfer; head and neck cancer; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Humans; Hypopharynx - surgery; Laryngeal Neoplasms - drug therapy; Laryngeal Neoplasms - radiotherapy; Laryngeal Neoplasms - surgery; Laryngectomy; Length of Stay; Male; Medical sciences; Middle Aged; organ preservation; Otorhinolaryngology. Stomatology; Postoperative Complications; radiation therapy; Reconstructive Surgical Procedures; Retrospective Studies; salvage therapy; squamous cell carcinoma; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the upper aerodigestive tract; Surgical Flaps; Time Factors; Treatment Outcome; Tumors; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; Wound Healing
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1097/00005537-200107000-00011

Purpose Previous series have demonstrated a 77% rate of major wound complications in salvage surgery of the larynx following organ preservation protocols. The purpose of this study is to determine the incidence of wound complications in these patients when microvascular free tissue transfers are used for reconstruction of the hypopharynx. Design Retrospective case series. Setting Academic tertiary care center. Patients and Method We reviewed the medical records of 42 patients with stage III and IV laryngeal squamous cell carcinoma treated with an organ‐sparing protocol consisting of induction chemotherapy followed by definitive radiation therapy. Ten of these patients who required surgical salvage were reconstructed using radial forearm free tissue or lateral arm transfer and constitute the study group. Main Outcome Measures Wound complications. Results Wound complications occurred in 2 patients (20%) undergoing free flap reconstruction of the hypopharynx after organ preservation protocols, which was significantly lower (P = .003) than previous reports using other forms of closure and/or reconstruction. One patient in this study group had a small pharyngocutaneous fistula that resolved with conservative therapy after 1 week. The other patient had a larger pharyngocutaneous fistula that resolved over 3 weeks. The mean interval from completion of the chemoradiation regimen to surgery was 21.3 months (range, 2–60 mo). The average free tissue flap size was 94.3 cm2 (range, 45–165 cm2). Average harvest and ischemia times were 59 minutes (range, 41–87 min) and 187.7 minutes (range, 120–240 min), respectively. All flaps survived, and one patient had a minor donor site wound dehiscence. The average hospital stay was 7.8 days. There were no mortalities in this series. Conclusions Our results suggest that free tissue transfer reconstruction of the hypopharynx is the preferred method of reconstruction following combined chemotherapy and radiation therapy protocols. Surgical complications are significantly reduced and hospital stays are minimized.