Κυριακή 23 Φεβρουαρίου 2020

Fistula prophylaxis with muscle-sparing, myofascial pectoralis major lobe in salvage laryngectomy].

[Fistula prophylaxis with muscle-sparing, myofascial pectoralis major lobe in salvage laryngectomy].:

[Fistula prophylaxis with muscle-sparing, myofascial pectoralis major lobe in salvage laryngectomy].

Laryngorhinootologie. 2020 Feb 20;:

Authors: Dejaco D, Rauchenwald T, Steinbichler T, Wolfram D, Morandi E, Appenroth E, Djedovic G, Pierer G, Riechelmann H

Abstract

BACKGROUND:  In recurrent hypopharyngeal/laryngeal squamous cell carcinoma after radiation salvage-laryngectomy (salvage-LE) represents the best curative treatment option. Pre-irradiation promotes development of pharyngocutaneous fistulas (pc-fistula). Transfer of unirradiated tissue to the surgical site reduces fistula rate. Frequently, a myocutaneous Pectoralis-major-flap (PMF) is applied. We describe a muscle sparing, myofascial PMF (ms-PMF) and its functional & aesthetic results.

METHODS:  For the ms-PMF, the pectoralis major is exposed via two 8 cm long subclavicular & submammary horizontal incisions. The pectoral branch of the thoracoacromial artery, which represents the blood supply for the ms-PMF, is identified between the clavicular and sternocostal aspect of the muscle. A cranciocaudal stripe of the pectoralis major is recovered and supraclaviculary transposed towards the pharynx. The clavicular and sternocostal part of the muscle remain untouched.The clear-margin resection rate (CMRR), mean overall survival (OS), complications, median length of hospital stay, & functional & esthetic outcome were assessed.

RESULTS:  In 25 patients, salvage-LE with ms-PMF was performed. The CMRR was 100 %, median OS 1.3 (follow-up 2.8) years, complications rate 16 % (4 complete lobe necroses, 3 pc-fistulas) and median inpatient stay 20 (11-78) days. Good functional outcome were observed: limitations of oral food intake occurred in 2-, limitations in voice rehabilitation in 3 patients. Wound healing disorders without lobe necrosis were not observed. The aesthetic results were appealing.

CONCLUSION:  The ms-PMF is a less invasive & safe procedure for fistula prophylaxis in salvage-LE with favorable functional & aesthetic results.

PMID: 32079025 [PubMed - as supplied by publisher]

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