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The Role of Pectoralis Major Muscle Flap in Salvage Total Laryngectomy
Ziv Gil, MD, PhD;
Amar Gupta, MD;
Ben Kummer, MD;
Peter G. Cordeiro, MD;
Dennis H. Kraus, MD;
Jatin P. Shah, MD;
Snehal G. Patel, MD
Arch Otolaryngol Head Neck Surg. 2009;135(10):1019-1023.
Objective To assess the utility of the pectoralis major muscle flap (PMMF) in patients undergoing salvage total laryngectomy.
Design Retrospective cohort analysis.
Setting Tertiary care cancer center.
Patients The study included 461 patients who underwent laryngectomy. Eighty of them underwent salvage surgery with primary pharyngeal closure.
Interventions Of the 80 patients, 69 (86%) underwent primary pharyngeal closure alone and 11 (14%) underwent a PMMF, which was used to buttress the pharyngeal suture line.
Main Outcome Measure Two hundred thirty-six variables were recorded for each patient. Complications related to pharyngeal closure were measured.
Results Sixty-four percent of the patients who underwent PMMF also underwent chemoradiation therapy as the initial definitive treatment compared with 25% in the non-PMMF group (P = .03). On multivariate analysis, chemoradiation therapy was the only independent predictor of pharyngocutaneous fistula formation (relative risk, 1.82; P = .02). Nevertheless, the pharyngocutaneous fistula rate was similar in the PMMF (27%) and the non-PMMF (24%) groups. Furthermore, similar durations of tube feeding, days to oral feeding, and hospitalization period were recorded in both groups.
Conclusion The PMMF should be used judiciously as a surgical adjunct in high-risk patients, with the goal of minimizing the risk for the development of a pharyngocutaneous fistula.
Author Affiliations: Head and Neck Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York. Dr Gil is now with the Skull Base Surgery Service, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
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