Complications of pectoralis major myo-cutaneous flap, anterolateral thigh flap and radial forearm free flap after total laryngectomy with partial pharyngectomy: A systematic review and network meta-analysis

Reconstruction of Partial Hypopharyngeal Defects following Total Laryngectomy: A Systematic Review and Meta-Analysis

BACKGROUND

Various operative techniques exist to reconstruct partial hypopharyngeal defects following total laryngectomy. The current study aimed to investigate and compare complications and functional results following commonly used reconstructive techniques.

METHODS

A systematic review and meta-analysis were performed using studies that investigated outcomes after the reconstruction of a partial hypopharyngeal defect. The outcomes of interest were fistulas, strictures, flap failure, swallowing function and postoperative speech.

RESULTS

Of the 4035 studies identified, 23 were included in this review. Four common reconstructive techniques were reported, with a total of 794 patients: (1) pectoralis major myocutaneous and (2) myofascial flap, (3) anterolateral thigh free flap and (4) radial forearm free flap. Fistulas occurred significantly more often than pectoralis major myocutaneous flaps (34%, 95% CI 23-47%) compared with other flaps (p < 0.001). No significant differences in the rates of strictures or flap failure were observed. Pectoralis major myofascial flaps were non-inferior to free-flap reconstructions. Insufficient data were available to assess speech results between flap types.

CONCLUSION

Pectoralis myocutaneous flaps should not be the preferred method of reconstruction for most patients, considering their significantly higher rate of fistulas. In contrast, pectoralis major myofascial flaps yield promising results compared to free-flap reconstructions, warranting further investigation.

Pharyngeal reconstruction after total laryngectomy with sliding epiglottis: technical aspects with retrospective review

Introduction

Several techniques have been employed for defect reconstruction after total laryngectomy, among others sliding epiglottoplasty. As there is a paucity of data on sliding epiglottoplasty after total laryngectomy, this study aimed to present this reconstruction technique in detail with the retrospective analysis of the patients.

Methods

We retrospectively reviewed single-center medical records of patients who underwent pharyngeal reconstruction after total laryngectomy between 2007-2013, with a follow-up to 2020. The study included patients who had total laryngectomy performed followed by a primary closure or sliding epiglottoplasty. The patients were divided according to the pharyngeal reconstruction technique: sliding epiglottis (n = 38) and primary closure (n = 120).

Results

The baseline characteristics of patients, TNM stages, and previous treatment strategies did not differ significantly between the sliding epiglottis and primary closure group. The postoperative complication rates, including the pharyngocutaneous fistulae formation and strictures were comparable between the analyzed groups; however, a slightly higher incidence of pharyngocutaneus fistulae was noted within the patients after sliding epiglottoplasty. Overall 3-year survival of patients who underwent the epiglottoplasty and primary closure group were 73.7% vs. 57.5%, respectively.

Conclusions

Sliding epiglottoplasty is considered a safe reconstruction technique. Although slightly better outcomes were noted within the epiglottoplasty group, it is still considered inferior to the primary closure. This technique ought to be considered in meticulously selected patients in whom primary closure is not feasible, epiglottis with nearby structures is spared from disease, and when the distal flaps are less appropriate or contraindicated.

Comparison of the outcomes of anterolateral thigh flap and peroneal flap in total laryngectomy reconstruction

Background

We usually use an ALT or peroneal flap in total laryngectomy reconstruction, depending on the surgeons' preference. No direct comparison of the outcomes of the ALT flap and peroneal flap exists.

Methods

From 2014 to 2022, we reviewed patients who had total laryngectomy and were reconstructed with an ALT flap and peroneal flap. Patient characteristics and surgical outcomes were collected and compared.

Results

The peroneal group had a significantly higher risk of neopharynx leakage (40% vs. 13.2%, p = .020) and late pharyngocutaneous fistula formation (30% vs. 5.3%, p = .009) than the ALT group. Peroneal flap was found to be the only independent risk factor for neopharynx leakage (p = .025, odds ratio [OR] = 5.5) and late pharyngocutaneous fistula formation (p = .02, OR = 7.7) in multivariate logistic regression.

Conclusion

In the reconstruction of total laryngectomy, the ALT flap is preferable over the peroneal flap.