Researchers examined that the pectoralis major flap is a reconstructive option to consider in the treatment of pharyngocutaneous fistula after a total laryngectomy. There are not large studies assessing variables related to pharyngocutaneous fistula recurrence after removal of the larynx. Our objectives were to review the results obtained with this type of treatment when pharyngocutaneous fistula appears in laryngectomized patients and to evaluate variables related to the results.
The appearance of a pharyngocutaneous fistula (PCF) remains one of the most common and difficult postoperative complications in patients undergoing a total laryngectomy. This complication increases morbidity, length of hospitalization, and costs associated with treatment. The reported incidence of pharyngocutaneous fistulas after total laryngectomy is highly variable, ranging between 4% and 65%.
Treatment for PCF is usually conservative. It consists of medical treatment with antibiotics, enteral nutrition with a nasogastric tube, and daily local wound care including removal of all necrotic tissue, cleaning with an antiseptic solution, and placement of a compressive dressing. Between 62% and 86% of PCF spontaneously close with medical treatment, particularly those in non-irradiated patients with small fistulas.
Several studies have shown the efficiency of the PMF in closing the pharynx during a laryngectomy and hence reducing the frequency of postoperative PCF. However, to our knowledge, no studies have been performed in a large series of patients to examine the usefulness of PMF to treat postoperative PCFs or to determine the variables related to the appearance of fistula recurrence.
The results of multivariate analysis showed that the use of the PMF in an emergency situation increased the risk of fistula recurrence almost nine-fold. In our opinion, the increased risk of fistula recurrence when PMF reconstruction is carried out in an emergency background is justified by the precarious systemic and local context in which surgery is performed.
The main advantages in using the pectoralis flap in the repair of PCF are that it is a technically simple procedure and that it provides a well-vascularized tissue with a pedicle that easily reaches the cervical region. Disadvantages of this flap are the morbidity caused at the donor site, and excessive bulk depending on the phenotype of the patient, especially in cases where a myocutaneous flap is used.
The myocutaneous or fasciomuscular PMF is a useful reconstructive tool for the repair of PCFs after laryngectomy. Placing salivary by-pass tubes during fistula repair significantly reduces hospital stay and the severity of complications of PCF recurrence.