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Fussey J, Kudpaje A, Clark J, Palme CE. Management of Parastomal Recurrence Following Total Laryngectomy. Indian J Otolaryngol Head Neck Surg 2023; 75:2657-2661. [PMID: 37636805 PMCID: PMC10447848 DOI: 10.1007/s12070-023-03613-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/18/2023] [Indexed: 03/06/2023] Open
Abstract
Parastomal recurrence occurs in around 5% of patients undergoing total laryngectomy for laryngeal squamous cell carcinoma. It carries a poor prognosis which has changed little over the last 50 years, and poses a significant challenge to the head and neck surgeon. At present, surgical excision offers the only realistic chance of cure, although patients must be selected carefully following thorough work-up and in-depth multidisciplinary team discussion. This article provides a review of the literature on the management of parastomal recurrence following total laryngectomy.
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Affiliation(s)
- Jonathan Fussey
- Department of Head and Neck Surgery, University Hospitals Birmingham, Birmingham, UK
| | - Akshay Kudpaje
- Department of Head and Neck Surgical Oncology, Cytecare Cancer Hospitals, Bangalore, India
| | - Jonathan Clark
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, Sydney, Australia
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Carsten E. Palme
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, Sydney, Australia
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Dai X, Li P, Xu H. Free Flap Transplantation on the repair of defects caused by oral and maxillofacial tumors resection. Pak J Med Sci 2019; 35:1339-1343. [PMID: 31489003 PMCID: PMC6717448 DOI: 10.12669/pjms.35.5.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To investigate the efficacy of free flap transplantation on the repair of tissue defects after oral and maxillofacial malignant tumor resection and its effects on serum sialic acid (SA) and interleukin-2 (IL-2). Methods Fifty-eight patients with oral and maxillofacial tumors were enrolled and set as the observation group. After the tumor resection, free flap transplantation was performed for postoperative repair. The postoperative efficacy, adverse reactions and follow-up indicators were observed. Moreover, 55 patients with benign tumors were enrolled into the control group, and 55 healthy persons were set as the healthy group. The levels of SA and IL-2 of the three groups were detected. Results In the observation group, 55 patients were successfully repaired (94.83%); 15 patients had adverse reactions after surgery. The follow-up duration was two to four years, and 45 patients survived for three years, with a survival rate of 77.59%. Before treatment, the serum SA level of patients with oral malignant tumor was significantly higher than those of the control group and healthy group, while the IL-2 level was significantly lower than those of the other two groups, and the differences were statistically significant (P<0.05). The serum IL-2 level in the observation group one day and fourteen days after surgery was higher than that before surgery, while the serum SA level was lower than that before surgery; the differences were statistically significant (P<0.05). Conclusion The application of free flap transplantation in the repair of postoperative tissue defects of oral and maxillofacial tumor resection is effective and has less complications, and the determination of both serum SA and IL-2 levels offers important references to recovery of patients with oral and maxillofacial tumors and prognosis evaluation.
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Affiliation(s)
- Xuemei Dai
- Xuemei Dai, Health Management Center, Binzhou People's Hospital, Shandong 256600, China
| | - Pengchong Li
- Pengchong Li, Stomatology Department, Binzhou People's Hospital, Shandong 256600, China
| | - Haiyan Xu
- Haiyan Xu, Endoscopy Room, Binzhou People's Hospital, Shandong 256600, China
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Kim MS, Lim JH, Jin YJ, Jang JH, Hah JH. Trichloroacetic Acid Chemocauterization: A Simple Method to Close Small Tracheocutaneous Fistula. Ann Otol Rhinol Laryngol 2016; 125:644-7. [PMID: 27067152 DOI: 10.1177/0003489416642788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of chemocauterization using trichloroacetic acid with or without suturing for the small tracheocutaneous fistula closure METHODS The Seoul National University Hospital database was analyzed retrospectively for 55 patients with a small tracheocutaneous fistula measuring less than 5 × 5 mm(2). Of these, 39 patients were treated by chemocauterization only, and 16 patients were treated by chemocauterization with suturing. Demographic, perioperative data, and treatment outcomes were evaluated for all patients. RESULTS The success rate of single trial was 56.4% (31/55), and the final success rate after repeated procedures if indicated was 80.0% (44/55). There were no statistically significant differences in age, sex, cannulation period, fistula size, presence or absence of maturation suture during tracheostomy, number of procedures, and success rates. Interval between decannulation and procedure was significantly different among 2 groups. CONCLUSIONS Trichloroacetic acid chemocauterization could be a simple, noninvasive, and safe method to close small tracheocutaneous fistula.
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Affiliation(s)
- Min-Su Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Gyeonggi-do, Korea
| | - Jae Hyun Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Young Ju Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jeong Hun Jang
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - J Hun Hah
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
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Abstract
Tracheostoma wounds are complex defects that commonly occur in patients with vessel-depleted necks after cervical lymphadenectomy, who have multiple medical comorbidities, and a history of radiation therapy. The authors report reconstruction of 5 tracheostoma wounds using a pedicled, supraclavicular artery island flap as a reconstructive alternative. There were no flap losses, fistulas or leaks, revisions, or other complications. The supraclavicular artery island flap is a versatile, reliable, and effective option for tracheostoma reconstruction.
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Ghali S, Chang EI, Rice DC, Walsh GL, Yu P. Microsurgical reconstruction of combined tracheal and total esophageal defects. J Thorac Cardiovasc Surg 2015; 150:1261-6. [PMID: 25998466 DOI: 10.1016/j.jtcvs.2011.10.100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 09/08/2011] [Accepted: 10/09/2011] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Lesions involving both the trachea and the esophagus are often considered inoperable because of the lack of reliable reconstruction. The purpose of this study was to review our experience of combined supercharged jejunal and other flaps for tracheal and esophageal reconstruction. METHODS A retrospective review of 5 consecutive cases with combined tracheal and total esophageal defects was performed. The esophageal defect was reconstructed with a supercharged jejunal flap, and the trachea was reconstructed with a free anterolateral thigh flap or a pedicled muscle flap. RESULTS Primary diagnosis included tracheostoma recurrence after a total laryngectomy for laryngeal cancer in 2 patients and tracheoesophageal fistula due to esophageal stenting for complications from prior treatment for non-Hodgkin's lymphoma, parathyroid cancer, and esophageal cancer in 3 patients, respectively. Tracheal and esophageal reconstructions were staged in 4 patients, and 1 patient received simultaneous reconstruction. Tracheal necrosis developed in 1 patient with a mediastinal tracheostoma, and the patient eventually died of infection 2 months later. The other 4 patients recovered well and resumed an oral diet. CONCLUSIONS Complex and often life-threatening lesions involving both the trachea and the esophagus are not necessarily inoperable. With careful planning, these combined defects can be safely reconstructed with multiple flaps with good functional outcomes and reasonable survival.
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Affiliation(s)
- Shadi Ghali
- Department of Plastic Surgery, the University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Edward I Chang
- Department of Plastic Surgery, the University of Texas MD Anderson Cancer Center, Houston, Tex
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, the University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, the University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Peirong Yu
- Department of Plastic Surgery, the University of Texas MD Anderson Cancer Center, Houston, Tex.
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Pallua N, Wolter TP. Defect classification and reconstruction algorithm for patients with tracheostomy using the tunneled supraclavicular artery island flap. Langenbecks Arch Surg 2010; 395:1115-9. [DOI: 10.1007/s00423-010-0654-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Accepted: 05/18/2010] [Indexed: 11/29/2022]
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Caliceti U, Piccin O, Cavicchi O, Contedini F, Cipriani R. Anterolateral thigh free flap for tracheal reconstruction after parastomal recurrence. Head Neck 2009; 31:1107-11. [PMID: 19189336 DOI: 10.1002/hed.20992] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Stomal recurrence after total laryngectomy is 1 of the most serious issues in head and neck surgery, both because of the complexity of its management and because of its morbidity. Prior to the introduction of free-tissue transfer, mediastinal tracheostomy has been the standard reconstructive procedure with high rate of complications. The ideal reconstructive solution to these problems must provide well-vascularized soft tissues that can cover the defect after resection and also allow suturing of the tracheal remnant to skin edges without tension. METHODS AND RESULTS We describe a case of a 56-year-old man with stomal recurrence after total laryngectomy treated by the use of a tubed anterolateral thigh (ALT) flap to elongate the shortened trachea and simultaneously cover the cervical skin defect. CONCLUSIONS The ALT can be accepted as an ideal free-flap choice for stomal recurrence, because it has maximal reconstructive capacity and produces minimal donor-site morbidity.
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Affiliation(s)
- Umberto Caliceti
- ENT Department, S. Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
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Rennekampff HO, Tenenhaus M. Turnover Flap Closure of Recalcitrant Tracheostomy Fistula: A Simplified Approach. Plast Reconstr Surg 2007; 119:551-5. [PMID: 17230089 DOI: 10.1097/01.prs.0000246378.43769.6d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Chronic and nonclosing tracheostomy fistula can often significantly impair quality of life, vocalization, and local hygiene. Although many of these fistulas close on their own after decannulation or after local debridement, a significant percentage do not and require flap closure. In this article, the authors present their experience with a multilayered flap closure technique that has proven reliable, quick, and extremely easy to perform, even in recalcitrant cases. METHODS A medially based turnover skin flap closes the tracheal defect without tension and does not narrow the lumen. Double and layered local muscular coverage provides healthy soft-tissue coverage and eliminates a tethered and depressed scar appearance. Skin closure respects relaxed tension lines. RESULTS Six patients with recalcitrant tracheostomy fistula have to date undergone this repair without recurrence, and cosmesis has been excellent. CONCLUSIONS Complicated and recurrent tracheal fistulas are successfully treated with a tension-free, multilayered flap reconstruction; the design incorporates fundamental aesthetic and reconstructive principles.
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Affiliation(s)
- Hans-Oliver Rennekampff
- Department of Plastic, Hand, Reconstructive, and Burn Surgery, BG Trauma Center, University of Tuebingen, Germany
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McCarthy CM, Kraus DH, Cordeiro PG. Tracheostomal and Cervical Esophageal Reconstruction with Combined Deltopectoral Flap and Microvascular Free Jejunal Transfer after Central Neck Exenteration. Plast Reconstr Surg 2005; 115:1304-10; discussion 1311-3. [PMID: 15809590 DOI: 10.1097/01.prs.0000156916.82294.98] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Combined defects of the skin, larynx, pharynx, and esophagus after central compartment exenteration of the neck can be extremely difficult to reconstruct. The objective of this article is to evaluate reconstruction of the central compartment using a combination of free jejunal transfer for pharyngoesophageal reconstruction, together with regional deltopectoral flaps for tracheostomal reconstruction and cutaneous resurfacing. Myocutaneous flaps, such as pectoralis major and latissimus dorsi flaps, have been used previously for external coverage but can be bulky, causing obstruction of the tracheostoma. METHODS From 1995 to 2002, seven patients underwent reconstruction of the central compartment with seven jejunal and nine deltopectoral flaps. Five patients required resection for tracheostomal recurrence of squamous cell carcinoma, and two patients required resection for massive pharyngocutaneous fistulas. Flap survival, complications, and outcomes were evaluated retrospectively. RESULTS The mean age of the patients was 68.7 years and the mean length of follow-up was 1.9 years. Overall free jejunal and deltopectoral flap survival was 100 percent, with no partial loss. All patients maintained an adequate airway with stomal patency. CONCLUSIONS These complicated defects can be effectively repaired with free jejunal transfers to restore continuity of the alimentary tract and deltopectoral flaps to reconstruct the tracheostoma and surrounding cutaneous defects. The deltopectoral flap provides a large volume of well-vascularized tissue that provides reliable coverage of the newly reconstructed cervical esophagus and exposed major vessels following exenteration of the central compartment. Its thin, pliable nature allows suturing of the tracheal remnants to skin edges without tension and avoids intraluminal prolapse of excess soft tissues, thus maintaining stomal patency.
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Affiliation(s)
- Colleen M McCarthy
- Department of Plastic and Reconstructive Surgery, Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Ferlito A, Silver CE, Rinaldo A, Kim H, Shaha AR. Parastomal recurrence: a therapeutic challenge. Acta Otolaryngol 2002; 122:222-9. [PMID: 11936918 DOI: 10.1080/00016480252814270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Alfio Ferlito
- Department of Otolaryngology-Head and Neck Surgery, University of Udine, Policlinico Universitario, Italy.
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