Free tissue transfer to manage salvage laryngectomy defects after organ preservation failure

Kirk P. Withrow, Eben L. Rosenthal, Christine G. Gourin, Glenn E. Peters, J. Scott Magnuson, David J Terris, William W. Carroll

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

OBJECTIVE: Salvage laryngectomy to treat organ preservation failures results in significantly higher local wound complications. Even in the absence of extralaryngeal disease, primary closure of laryngeal defects can result in protracted wound care problems. We hypothesize that even when sufficient mucosa is present to close the defect primarily, introduction of vascularized tissue to close the defect may improve outcomes. DESIGN: Retrospective case-control study. SETTING: Two academic tertiary care centers. PATIENTS AND METHODS: Patients undergoing salvage surgery for laryngeal squamous cell carcinoma between 2000 to 2006 were considered for this study. Patients requiring total laryngopharyngectomy or partial pharyngectomy were excluded. There were 37 patients who met study criteria: 17 patients underwent free flap reconstruction (16 radial forearm flaps and 1 rectus flap), and 20 patients underwent primary closure. The median follow-up was 12 (range, 4-60) months. Previous treatment consisted of chemoradiation for 41% of the reconstruction group and 35% of the primary closure group; the remainder were treated with primary radiation alone. MAIN OUTCOME MEASURES: Pharyngocutaneous fistula, stricture, length of hospitalization, feeding tube dependence. RESULTS: The free flap reconstruction group had a lower rate of fistula (18%) compared with the primary closure group (50%). A lower rate of stricture formation (18% vs. 25%) and feeding tube dependence (23% vs. 45%) was observed in the free flap reconstruction group compared with the primary closure group. The development of a fistula in either group resulted in a prolonged hospital stay (mean, 19 vs. 7 days) and additional procedures. CONCLUSION: Planned reconstruction of salvage laryngectomy defects with vascularized tissue is associated with a lower fistula rate and may improve outcomes.

Original languageEnglish (US)
Pages (from-to)781-784
Number of pages4
JournalLaryngoscope
Volume117
Issue number5
DOIs
StatePublished - May 1 2007

Fingerprint

Organ Preservation
Laryngectomy
Fistula
Free Tissue Flaps
Enteral Nutrition
Pharyngectomy
Pathologic Constriction
Wounds and Injuries
Forearm
Tertiary Care Centers
Case-Control Studies
Squamous Cell Carcinoma
Length of Stay
Mucous Membrane
Hospitalization
Radiation

Keywords

  • Complications
  • Fistula
  • Free tissue transfer
  • Head and neck cancer
  • Microvascular reconstruction
  • Organ preservation
  • Radiation therapy
  • Salvage laryngectomy
  • Stricture
  • Surgery

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Withrow, K. P., Rosenthal, E. L., Gourin, C. G., Peters, G. E., Magnuson, J. S., Terris, D. J., & Carroll, W. W. (2007). Free tissue transfer to manage salvage laryngectomy defects after organ preservation failure. Laryngoscope, 117(5), 781-784. https://doi.org/10.1097/MLG.0b013e3180332e39

Free tissue transfer to manage salvage laryngectomy defects after organ preservation failure. / Withrow, Kirk P.; Rosenthal, Eben L.; Gourin, Christine G.; Peters, Glenn E.; Magnuson, J. Scott; Terris, David J; Carroll, William W.

In: Laryngoscope, Vol. 117, No. 5, 01.05.2007, p. 781-784.

Research output: Contribution to journalArticle

Withrow, KP, Rosenthal, EL, Gourin, CG, Peters, GE, Magnuson, JS, Terris, DJ & Carroll, WW 2007, 'Free tissue transfer to manage salvage laryngectomy defects after organ preservation failure', Laryngoscope, vol. 117, no. 5, pp. 781-784. https://doi.org/10.1097/MLG.0b013e3180332e39
Withrow, Kirk P. ; Rosenthal, Eben L. ; Gourin, Christine G. ; Peters, Glenn E. ; Magnuson, J. Scott ; Terris, David J ; Carroll, William W. / Free tissue transfer to manage salvage laryngectomy defects after organ preservation failure. In: Laryngoscope. 2007 ; Vol. 117, No. 5. pp. 781-784.
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abstract = "OBJECTIVE: Salvage laryngectomy to treat organ preservation failures results in significantly higher local wound complications. Even in the absence of extralaryngeal disease, primary closure of laryngeal defects can result in protracted wound care problems. We hypothesize that even when sufficient mucosa is present to close the defect primarily, introduction of vascularized tissue to close the defect may improve outcomes. DESIGN: Retrospective case-control study. SETTING: Two academic tertiary care centers. PATIENTS AND METHODS: Patients undergoing salvage surgery for laryngeal squamous cell carcinoma between 2000 to 2006 were considered for this study. Patients requiring total laryngopharyngectomy or partial pharyngectomy were excluded. There were 37 patients who met study criteria: 17 patients underwent free flap reconstruction (16 radial forearm flaps and 1 rectus flap), and 20 patients underwent primary closure. The median follow-up was 12 (range, 4-60) months. Previous treatment consisted of chemoradiation for 41{\%} of the reconstruction group and 35{\%} of the primary closure group; the remainder were treated with primary radiation alone. MAIN OUTCOME MEASURES: Pharyngocutaneous fistula, stricture, length of hospitalization, feeding tube dependence. RESULTS: The free flap reconstruction group had a lower rate of fistula (18{\%}) compared with the primary closure group (50{\%}). A lower rate of stricture formation (18{\%} vs. 25{\%}) and feeding tube dependence (23{\%} vs. 45{\%}) was observed in the free flap reconstruction group compared with the primary closure group. The development of a fistula in either group resulted in a prolonged hospital stay (mean, 19 vs. 7 days) and additional procedures. CONCLUSION: Planned reconstruction of salvage laryngectomy defects with vascularized tissue is associated with a lower fistula rate and may improve outcomes.",
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