Pectoralis Major Myocutaneous Flap versus Free Fasciocutaneous Flap for Reconstruction of Partial Hypopharyngeal Defects: What Should We Be Doing?

Jerry W. Chao; Jason A. Spector; Erin M. Taylor; David M. Otterburn; David I. Kutler; Salvatore M. Caruana; Christine H. Rohde

doi:10.1055/s-0034-1395417

Journal of Reconstructive Microsurgery, Inhaltsverzeichnis

J Reconstr Microsurg 2015; 31(03): 198-204
DOI: 10.1055/s-0034-1395417

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pectoralis Major Myocutaneous Flap versus Free Fasciocutaneous Flap for Reconstruction of Partial Hypopharyngeal Defects: What Should We Be Doing?

Jerry W. Chao

¹Division of Plastic and Reconstructive Surgery, Columbia University Medical Center, New York–Presbyterian Hospital, New York, New York

,

Jason A. Spector

²Division of Plastic and Reconstructive Surgery, Weill Cornell Medical Center, New York–Presbyterian Hospital, New York, New York

,

Erin M. Taylor

¹Division of Plastic and Reconstructive Surgery, Columbia University Medical Center, New York–Presbyterian Hospital, New York, New York

,

David M. Otterburn

²Division of Plastic and Reconstructive Surgery, Weill Cornell Medical Center, New York–Presbyterian Hospital, New York, New York

,

David I. Kutler

³Department of Otolaryngology, Head and Neck Surgery, Weill Cornell Medical Center, New York–Presbyterian Hospital, New York, New York

,

Salvatore M. Caruana

⁴Department of Otolaryngology, Head and Neck Surgery, Columbia University Medical Center, New York–Presbyterian Hospital, New York, New York

,

Christine H. Rohde

¹Division of Plastic and Reconstructive Surgery, Columbia University Medical Center, New York–Presbyterian Hospital, New York, New York

› Institutsangaben

Abstract

Background Partial hypopharyngeal defects are most commonly reconstructed with the pectoralis major myocutaneous flap (PMMF) or free fasciocutaneous (FFC) flap. The purpose of this study is to determine the ideal method for reconstruction of partial hypopharyngeal defects by reviewing our institutional experience and the literature.

Methods A retrospective review of partial hypopharyngeal reconstructions since 2009 was performed. A National Library of Medicine search of studies on partial hypopharyngeal reconstruction since 1988 was performed. Data on complications, diet, and speech were extracted and pooled.

Results A total of 18 patients were studied—9 had PMMF reconstruction and 9 had FFC reconstruction. Operative time (8.75 vs. 13.0 hours, p = 0.0003) was shorter in the PMMF group. Pharyngocutaneous fistula developed in one PMMF patient (11.1%) and two FFC patients (22.2%). Late strictures occurred in three PMMF patients. Six patients in each group (66.7%) progressed to a regular diet. Three patients in each group produced tracheoesophageal speech after TEP. Literature review identified 36 relevant studies, with 301 patients reconstructed with PMMF and 605 patients with FFC. Pooled-data analysis revealed that PMMF had higher reported rates of fistula (24.7 vs. 8.9%, p < 0.0001) and requirement for second surgery (11.3 vs. 5.5%, p = 0.04). There was no difference in stricture rates or progression to regular diet. Fewer PMMF patients produced tracheoesophageal speech (17.5 vs. 52.1%, p < 0.0001).

Conclusions PMMF and FFC flaps are valid approaches to reconstructing partial hypopharyngeal defects, though rates in the literature of fistula, need for revisional surgery, and tracheoesophageal speech after laryngectomy are more favorable after free flap reconstruction.

Keywords

hypopharynx - reconstruction - pectoralis major flap - free flap

Volltext

Referenzen

References
1 Hui Y, Wei WI, Yuen PW, Lam LK, Ho WK. Primary closure of pharyngeal remnant after total laryngectomy and partial pharyngectomy: how much residual mucosa is sufficient?. Laryngoscope 1996; 106 (4) 490-494
2 Shah JP, Haribhakti V, Loree TR, Sutaria P. Complications of the pectoralis major myocutaneous flap in head and neck reconstruction. Am J Surg 1990; 160 (4) 352-355
3 Vartanian JG, Carvalho AL, Carvalho SM, Mizobe L, Magrin J, Kowalski LP. Pectoralis major and other myofascial/myocutaneous flaps in head and neck cancer reconstruction: experience with 437 cases at a single institution. Head Neck 2004; 26 (12) 1018-1023
4 Milenović A, Virag M, Uglesić V, Aljinović-Ratković N. The pectoralis major flap in head and neck reconstruction: first 500 patients. J Craniomaxillofac Surg 2006; 34 (6) 340-343
5 Piazza C, Taglietti V, Nicolai P. Reconstructive options after total laryngectomy with subtotal or circumferential hypopharyngectomy and cervical esophagectomy. Curr Opin Otolaryngol Head Neck Surg 2012; 20 (2) 77-88
6 Fabian RL. Pectoralis major myocutaneous flap reconstruction of the laryngopharynx and cervical esophagus. Laryngoscope 1988; 98 (11) 1227-1231
7 Coleman III JJ. Reconstruction of the pharynx after resection for cancer. A comparison of methods. Ann Surg 1989; 209 (5) 554-560 , discussion 561
8 Lam KH, Ho CM, Lau WF, Wei WI, Wong J. Immediate reconstruction of pharyngoesophageal defects. Preference or reference. Arch Otolaryngol Head Neck Surg 1989; 115 (5) 608-612
9 Chantrain G, Deraemaecker R, Andry G, Dor P. Wide vertical hemipharyngolaryngectomy with immediate glottic and pharyngeal reconstruction using a radial forearm free flap: preliminary results. Laryngoscope 1991; 101 (8) 869-875
10 Su CY, Hwang CF. Near-total laryngopharyngectomy with pectoralis major myocutaneous flap in advanced pyriform carcinoma. J Laryngol Otol 1993; 107 (9) 817-820
11 Anthony JP, Singer MI, Deschler DG, Dougherty ET, Reed CG, Kaplan MJ. Long-term functional results after pharyngoesophageal reconstruction with the radial forearm free flap. Am J Surg 1994; 168 (5) 441-445
12 Lydiatt WM, Kraus DH, Cordeiro PG, Hidalgo DA, Shah JP. Posterior pharyngeal carcinoma resection with larynx preservation and radial forearm free flap reconstruction: a preliminary report. Head Neck 1996; 18 (6) 501-505
13 Schuller DE, Mountain RE, Nicholson RE, Bier-Laning CM, Powers B, Repasky M. One-stage reconstruction of partial laryngopharyngeal defects. Laryngoscope 1997; 107 (2) 247-253
14 Deschler DG, Doherty ET, Reed CG, Singer MI. Quantitative and qualitative analysis of tracheoesophageal voice after pectoralis major flap reconstruction of the neopharynx. Otolaryngol Head Neck Surg 1998; 118 (6) 771-776
15 Nakatsuka T, Harii K, Ueda K , et al. Preservation of the larynx after resection of a carcinoma of the posterior wall of the hypopharynx: versatility of a free flap patch graft. Head Neck 1997; 19 (2) 137-142
16 Ninković M, Harpf C, Gunkel A, Schwabegger A, Thumfart W, Anderl H. One-stage reconstruction of defects in the hypopharyngeal region with free flaps. Scand J Plast Reconstr Surg Hand Surg 1999; 33 (1) 31-39
17 Varvares MA, Cheney ML, Gliklich RE , et al. Use of the radial forearm fasciocutaneous free flap and montgomery salivary bypass tube for pharyngoesophageal reconstruction. Head Neck 2000; 22 (5) 463-468
18 Azizzadeh B, Yafai S, Rawnsley JD , et al. Radial forearm free flap pharyngoesophageal reconstruction. Laryngoscope 2001; 111 (5) 807-810
19 Julieron M, Kolb F, Schwaab G , et al. Surgical management of posterior pharyngeal wall carcinomas: functional and oncologic results. Head Neck 2001; 23 (2) 80-86
20 Teknos TN, Myers LL, Bradford CR, Chepeha DB. Free tissue reconstruction of the hypopharynx after organ preservation therapy: analysis of wound complications. Laryngoscope 2001; 111 (7) 1192-1196
21 Baek CH, Kim BS, Son YI, Ha B. Pharyngoesophageal reconstruction with lateral thigh free flap. Head Neck 2002; 24 (11) 975-981
22 Iwai H, Tsuji H, Tachikawa T , et al. Neoglottic formation from posterior pharyngeal wall conserved in surgery for hypopharyngeal cancer. Auris Nasus Larynx 2002; 29 (2) 153-157
23 Spriano G, Pellini R, Roselli R. Pectoralis major myocutaneous flap for hypopharyngeal reconstruction. Plast Reconstr Surg 2002; 110 (6) 1408-1413 , discussion 1414–1416
24 Disa JJ, Pusic AL, Hidalgo DA, Cordeiro PG. Microvascular reconstruction of the hypopharynx: defect classification, treatment algorithm, and functional outcome based on 165 consecutive cases. Plast Reconstr Surg 2003; 111 (2) 652-660 , discussion 661–663
25 Jol JK, Quak JJ, de Bree R, Leemans CR. Larynx preservation surgery for advanced posterior pharyngeal wall carcinoma with free flap reconstruction: a critical appraisal. Oral Oncol 2003; 39 (6) 552-558
26 Clark JR, Gilbert R, Irish J, Brown D, Neligan P, Gullane PJ. Morbidity after flap reconstruction of hypopharyngeal defects. Laryngoscope 2006; 116 (2) 173-181
27 Withrow KP, Rosenthal EL, Gourin CG , et al. Free tissue transfer to manage salvage laryngectomy defects after organ preservation failure. Laryngoscope 2007; 117 (5) 781-784
28 Corten EM, Schellekens PP, Hage JJ, Kon M. Clinical outcome after pedicled segmental pectoralis major island flaps for head and neck reconstruction. Ann Plast Surg 2009; 63 (3) 292-296
29 Hong JW, Jeong HS, Lew DH , et al. Hypopharyngeal reconstruction using remnant narrow pharyngeal wall as omega-shaped radial forearm free flap. J Craniofac Surg 2009; 20 (5) 1334-1340
30 Morrissey AT, O'Connell DA, Garg S, Seikaly H, Harris JR. Radial forearm versus anterolateral thigh free flaps for laryngopharyngectomy defects: prospective, randomized trial. J Otolaryngol Head Neck Surg 2010; 39 (4) 448-453
31 Wu PY, Kuo YR, Jeng SF, Hsu CM, Su CY. Functional outcomes of patients with advanced pyriform sinus cancer treated with extended near-total laryngopharyngectomy and free fasciocutaneous flap reconstruction. Eur Arch Otorhinolaryngol 2010; 267 (12) 1951-1956
32 Spyropoulou GA, Lin PY, Chien CY, Kuo YR, Jeng SF. Reconstruction of the hypopharynx with the anterolateral thigh flap: defect classification, method, tips, and outcomes. Plast Reconstr Surg 2011; 127 (1) 161-172
33 Joo YH, Sun DI, Cho KJ, Park JO, Kim MS. Fasciocutaneous free flap reconstruction for squamous cell carcinoma of the hypopharynx. Eur Arch Otorhinolaryngol 2011; 268 (2) 289-294
34 Sinclair CF, Rosenthal EL, McColloch NL , et al. Primary versus delayed tracheoesophageal puncture for laryngopharyngectomy with free flap reconstruction. Laryngoscope 2011; 121 (7) 1436-1440
35 Tan NC, Yeh MC, Shih HS, Nebres RP, Yang JC, Kuo YR. Single free anterolateral thigh flap for simultaneous reconstruction of composite hypopharyngeal and external neck skin defect after head and neck cancer ablation. Microsurgery 2011; 31 (7) 524-528
36 Yamawaki S, Sawabe K, Kataoka K, Tanaka S, Suzuki S. The combined use of hyoid bone flap and radial forearm free flap for reconstruction following partial laryngopharyngectomy. Ann Plast Surg 2011; 66 (3) 257-260
37 Ho MW, Houghton L, Gillmartin E , et al. Outcomes following pharyngolaryngectomy reconstruction with the anterolateral thigh (ALT) free flap. Br J Oral Maxillofac Surg 2012; 50 (1) 19-24
38 López F, Obeso S, Camporro D, Fueyo A, Suárez C, Llorente JL. Outcomes following pharyngolaryngectomy with fasciocutaneous free flap reconstruction and salivary bypass tube. Laryngoscope 2013; 123 (3) 591-596
39 Montemari G, Rocco A, Galla S, Damiani V, Bellocchi G. Hypopharynx reconstruction with pectoralis major myofascial flap: our experience in 45 cases. Acta Otorhinolaryngol Ital 2012; 32 (2) 93-97
40 Sousa AA, Castro SM, Porcaro-Salles JM , et al. The usefulness of a pectoralis major myocutaneous flap in preventing salivary fistulae after salvage total laryngectomy. Braz J Otorhinolaryngol 2012; 78 (4) 103-107
41 Selber JC, Xue A, Liu J , et al. Pharyngoesophageal reconstruction outcomes following 349 cases. J Reconstr Microsurg 2014; 30 (9) 641-654
42 Couch ME. Laryngopharyngectomy with reconstruction. Otolaryngol Clin North Am 2002; 35 (5) 1097-1114
43 Welkoborsky HJ, Deichmüller C, Bauer L, Hinni ML. Reconstruction of large pharyngeal defects with microvascular free flaps and myocutaneous pedicled flaps. Curr Opin Otolaryngol Head Neck Surg 2013; 21 (4) 318-327
44 Murray DJ, Novak CB, Neligan PC. Fasciocutaneous free flaps in pharyngolaryngo-oesophageal reconstruction: a critical review of the literature. J Plast Reconstr Aesthet Surg 2008; 61 (10) 1148-1156
45 de Bree R, Reith R, Quak JJ, Uyl-de Groot CA, van Agthoven M, Leemans CR. Free radial forearm flap versus pectoralis major myocutaneous flap reconstruction of oral and oropharyngeal defects: a cost analysis. Clin Otolaryngol 2007; 32 (4) 275-282
46 Funk GF, Karnell LH, Whitehead S, Paulino A, Ricks J, Smith RB. Free tissue transfer versus pedicled flap cost in head and neck cancer. Otolaryngol Head Neck Surg 2002; 127 (3) 205-212
47 Prisman E, Miles BA, Genden EM. Prevention and management of treatment-induced pharyngo-oesophageal stricture. Lancet Oncol 2013; 14 (9) e380-e386
48 Martini DV, Har-El G, Lucente FE, Slavit DH. Swallowing and pharyngeal function in postoperative pharyngeal cancer patients. Ear Nose Throat J 1997; 76 (7) 450-453 , 456
49 Bastian RW, Riggs LC. Role of sensation in swallowing function. Laryngoscope 1999; 109 (12) 1974-1977
50 Shektman A, Silver C, Strauch B. A re-evaluation of hypopharyngeal reconstruction: pedicled flaps versus microvascular free flaps. Plast Reconstr Surg 1997; 100 (7) 1691-1696
51 Schechter GL. Complications of flaps and grafts in the oral cavity and pharynx. Laryngoscope 1983; 93 (3) 306-309
52 Medina JE, Nance A, Burns L, Overton R. Voice restoration after total laryngopharyngectomy and cervical esophagectomy using the duckbill prosthesis. Am J Surg 1987; 154 (4) 407-410
53 Guo W, Wang RW, Jiang YG, Zhao YP, Zhou JH, Gong TQ. Reconstruction of hypopharyngeal and cervical esophageal defect after resection of hypopharyngeal carcinoma: a new technique based on the use of bilateral platysma myocutaneous flaps. Dis Esophagus 2011; 24 (6) 404-410
54 Liu PH, Chiu ES. Supraclavicular artery flap: a new option for pharyngeal reconstruction. Ann Plast Surg 2009; 62 (5) 497-501