4.5 Article

Morbidity after flap reconstruction of hypopharyngeal defects

期刊

LARYNGOSCOPE
卷 116, 期 2, 页码 173-181

出版社

WILEY
DOI: 10.1097/01.mlg.0000191459.40059.fd

关键词

reconstruction; free flap; myocutaneous flap; squamous cell carcinoma; hypopharynx; pharyngectomy; laryngopharyngectomy

向作者/读者索取更多资源

Objectives: Laryngopharyngeal reconstruction continues to challenge in terms of operative morbidity and optimal functional results. The primary aim of this study is to determine whether complications can be predicted on the basis of reconstruction in patients undergoing pharyngectomy for tumors involving the hypopharynx. In addition, we detail a reconstructive algorithm for management of partial and total laryngopharyngectomy defects. Method A retrospective review was performed of 153 patients undergoing flap reconstruction for 85 partial and 68 circumferential pharyngectomies at a single institution over a 10-year period. There were 118 males and 35 females, the median age was 62 years, and mean follow up was 3.1 years. Pharyngectomy was performed for recurrence after radiotherapy in 80 patients and as primary surgery in 73. Free flap reconstruction was used in 42%, with 30 jejunal, 15 radial forearm, 11 anterolateral thigh, five rectus abdominis, and three gastroomental flaps. Gastric transposition and pectoralis major pedicle flap was used in 14% and 44% of patients, respectively. Morbidity was analyzed according to extent of defect, regional versus free flap, enteric versus fasciocutaneous free flap reconstruction, and the effect of laparotomy. Results: The total operative morbidity and mortality rate was 71% and 3%, respectively. The most common complications were hypocalcemia in 45%, pharyngocutaneous fistula in 33%, and wound complications in 25%. The late complication and stricture rate was 26% and 15%, respectively. On univariate analysis, circumferential defects were associated with increased total (P = .046) and flap-related morbidity (P =.037), hypocalcemia (P < .001), late complications (P = .003), and stricture (P = .009). Gastric transposition had increased total (P = .007), flap-related (P = .035), late complications (P = .034), and hypocalcemia (P = .001). Pharyngocutaneous fistula was increased in patients undergoing salvage pharyngectomy for radiation failure (P = .048) compared with primary surgery. On multivariate analysis, gastric transposition independently predicted for wound complications (P = .014) and fistula (P = .012). Circumferential defects predicted for flap-related morbidity (P = .030), hypocalcemia (P = .017), and late complications (P = .042). Tracheoesophageal speech was the method of voice restoration in 44% of patients. Oral diet was achieved in 93% of patients; however, 16% required gastrostomy tube feeds for either total or supplemental nutrition. Conclusion: The operative morbidity associated with pharyngeal reconstruction is substantial in terms of early and late complications. We were able to predict morbidity by defect extent and reconstruction type and initial treatment modality. Swallowing function is acceptable; however, less than half of the patients undergoing pharyngectomy had tracheoesophageal puncture voice restoration.

作者

我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。

评论

主要评分

4.5
评分不足

次要评分

新颖性
-
重要性
-
科学严谨性
-
评价这篇论文

推荐

暂无数据
暂无数据