Effectiveness of Sternocleidomastoid muscle flap in preventing of pharyngocutaneous fistula after total laryngectomy: A Prospective Case-Control Study
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Abstract
Background: Total laryngectomy is a complex surgical procedure used to remove the larynx, for the treatment of laryngeal cancer. One potential complication following this surgery is the pharyngocutaneous fistula, an abnormal connection between the pharynx and the skin of the neck. This complication significantly affects patient health, prolongs hospital stays, and increases healthcare costs. The sternocleidomastoid (SCM) muscle flap has emerged as an effective technique to prevent pharyngocutaneous fistula by providing well-vascularized tissue for wound healing. However, despite its potential benefits, there is a lack of sufficient research in this area, which hinders optimal patient outcomes. Objectives: This study aimed to compare the effectiveness of the SCM flap in preventing pharyngocutaneous fistula after total laryngectomy. Methods: A prospective case-control study was conducted, involving 16 patients who underwent total laryngectomy. The patients were divided into two groups: the control group, which underwent standard primary pharyngeal closure, and the study group, which received SCM flap augmentation. Various patient characteristics and outcomes were compared between the two groups. Results: None of the patients in the control group developed pharyngocutaneous fistula, while two patients in the SCM flap group did. However, the difference between the groups was not statistically significant (p=0.455). The length of hospital stay was similar between the groups. Although our study did not find a significant difference in fistula occurrence, the SCM flap still offers advantages in healing and reduces complications at the donor site. Further research with more participants is needed to evaluate the effectiveness of the SCM flap and explore other preventive measures for pharyngocutaneous fistula. Conclusions: Pharyngocutaneous fistula is a challenging complication after total laryngectomy. Our study found no significant difference in fistula occurrence between the SCM flap group and the control group. Further research is needed to enhance our understanding and improve management for better patient outcomes.
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References
Wang M, Xun Y, Wang K, Lu L, Yu A, Guan B, et al . Risk factors of pharyngocutaneous fistula after total laryngectomy: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2020; 277:585-599.
Dedivitis RA, Ribeiro KC, Castro MA, Nascimento PC. Pharyngocutaneous fistula following total laryngectomy. Acta Otorhinolaryngol Ital 2007; 27(1):2-5.
Virtaniemi JA, Kumpulainen EJ, Hirvikoski PP, et al. The incidence and etiology of post laryngectomy pharyngocutaneous fistulae. Head Neck 2001;23(1):29-33.
White HN, Golden B, Sweeny L, Carroll WR, Magnuson JS, Rosenthal EL. Assessment and incidence of salivary leak following laryngectomy. Laryngoscope 2012;122:1796-99.
Krouse JH, Metson R. Barium swallow is a predictor of salivary fistula following laryngec tomy. Otolaryngol Head Neck Surg 1992;106:254-57.
Lecle`re FM, Vacher C, Benchaa T. Blood supply to the human sternocleidomastoid muscle and its clinical implications for mandible reconstruction. Laryngoscope 2012;122:2402–6.
Khazaeni K, Rajati M, Shahabi A, et al. Use of a sternocleidomastoid myocutaneous flap based on the sternocleidomastoid branch of the superior thyroid artery to reconstruct extensive cheek defects. Aesth Plast Surg 2013;37:1167–70.
Chen HC, Chang HS. The sternocleidomastoid flap for oral cavity reconstruction: extended indications and technical modifications. J Oral Maxillofac Surg 2015;73:2429–39.
Albirmawy OA. Prevention of post laryngectomy pharyngocutaneous fistula using a sterno cleidomastoid muscle collar flap. J Laryngol Otol 2007;121:253-57.
Naghibzadeh M, Zojaji R. Using a sternocleidomastoid muscle flap to prevent postoperative pharyngocutaneous fistula after total laryngectomy: a study of 88 cases. Ear Nose Throat J 2014;93:362-65.
Ibrahim SG, Wahba BM, Elbatawi AM, Eltelety AM. Sternocleidomastoid flap augmentation of the pharyngeal closure after total laryngectomy. Eurr Arch Otorhinolaryngol 2017;274:3197-202.
Suzuki S, Yasunaga H, Matsui H. Pharyngocutaneous fistula and delay in free oral feeding after pharyngolaryngectomy for hypopharyngeal cancer. Head Neck 2016;38:625-30.
Singer MI, Blom ED. Selective myotomy for voice restoration after total laryngectomy. Arch Otolaryngol1981;107:670–3.
Sumarroca A. Repair of postlaryngectomy pharyngocutaneous fistulas using a pectoralis major flap. Braz J Otorhino laryngol 2019;85:351-56.
Guimarães AV, Aires FT, Dedivitis RA, Kulcsar MA, Ramos DM, Cernea CR, et al. Efficacy of pectoralis major muscle flap for pharyngocutaneous fistula prevent salvage total laryngec tomy: A systematic review. Head Neck 2016; 38:2317-21.
Sharma S, Chaukar DA, Laskar SG, Kapre N, Deshmukh A, Pai P, et al. Role of the pectoralis major myofascial flap in preventing pharyngocutaneous fistula following salvage laryngectomy.J Laryngol Otol 2016;130:860–4.
Cömert E, Tunçel Ü, Torun MT, Kiliç C, Cengiz AB, Sencan Z, et al. Pectoralis major myofascial flap in salvage laryngectomy. J Laryngol Otol 2014;128:714–19.