Effectiveness of sternocleidomastoid muscle flap in preventing pharyngocutaneous fistula after total laryngectomy: an open-label clinical trial
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Abstract
Background: Total laryngectomy (TLG) is a complex surgical procedure used to remove the larynx, often for the treatment of laryngeal cancer. One potential complication following this surgery is the development of pharyngocutaneous fistula (PCF), an abnormal connection between the pharynx and the skin of the neck. This complication significantly affects patient’s health, prolongs hospital stays, and increases healthcare costs. The sternocleidomastoid muscle (SCM) flap has emerged as an effective technique to prevent PCF by providing wellvascularized tissue for wound healing and minimizing complications. Objectives: This study aimed to compare the effectiveness of the SCM flap in preventing PCF after TLG. Methods: An open-label clinical trial was conducted, involving 16 patients who underwent TLG. 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 PCF, while two patients in the SCM flap group did. However, the difference between the groups was not statistically significant (p = 0.466). 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 to explore other preventive measures for PCF. Conclusions: PCF is a challenging complication after TLG. Our study, without pre-operative radiotherapy, found no significant difference in fistula occurrence between the SCM flap group and the control group.
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