Acellular dermal graft pharyngeal repair augmentation after laryngectomy. Am J Otolaryngol 2017;38(3):329-332
Date
02/16/2017Pubmed ID
28196713DOI
10.1016/j.amjoto.2017.01.036Scopus ID
2-s2.0-85011990211 (requires institutional sign-in at Scopus site) 2 CitationsAbstract
PURPOSE: Pharyngocutaneous fistula (PCF) after laryngectomy continues to be a serious complication, especially after radiation. Recruitment of non-radiated tissue into the surgical defect may decrease the risk of fistula. These techniques however have significant morbidity and increases operative time. We hypothesized that using acellular dermal graft to reinforce the pharyngeal closure could decrease the risk of fistula, without the added morbidity of a vascularized flap.
METHODS: We performed a retrospective chart review of all patients that underwent a laryngectomy between 2005 and 2015 at an acedemic tertiary referral center. Patients who underwent primary pharyngeal closure with Alloderm® reinforcement without any other flap reconstruction were identified. Basic demographics, previous treatment, operative technique and fistula were extracted from the medical records. The primary outcome was PCF rate. The time to closure, margin status and disease recurrence was also evaluated.
RESULTS: Among 16 patients with AlloDerm® augmentation, eight had primary laryngectomy and eight had salvage laryngectomy. A total of three in the salvage laryngectomy with prior history of radiation developed PCF. The fistula closed in all three cases with conservative treatment. There was no PCF in the primary laryngectomy group without prior history of radiation.
CONCLUSION: The rate of PCF among the salvage laryngectomy group with previous radiation did not differ from historical data. AlloDerm® can however, provide a simple alternative for repair in radiation patients where flap cannot be performed for pharyngeal reconstruction. In non-radiated patients, AlloDerm® augmentation may have a protective effect on fistula formation.
Author List
Pipkorn P, Sinha P, Zenga J, Graboyes E, Haughey BHAuthor
Joseph Zenga MD Assistant Professor in the Otolaryngology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Collagen
Female
Follow-Up Studies
Humans
Laryngectomy
Male
Middle Aged
Pharyngeal Neoplasms
Pharynx
Postoperative Complications
Retrospective Studies
Treatment Outcome
