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Fascio-cutaneous-free flaps as primary reconstruction in salvage total laryngectomy

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Introduction

Salvage total laryngectomy (STL) is the most common treatment for recurrent laryngeal cancer after (chemo)-radiotherapy [(C)RT]. In this scenario, a higher rate of local wound complications, such as pharyngo-cutaneous fistula (PCF) and pharyngo-esophageal stenosis (PES), is generally expected. The aim of the present study is to evaluate outcomes using a standardized reconstructive protocol.

Methods

Between 2009 and 2019, patients undergoing STL after (C)RT were collected at two referral hospitals with the objective of evaluating surgical outcomes using a standardized reconstructive policy based on the use of fascio-cutaneous free flaps as inlay patch grafts and a long-lasting salivary bypass stent.

Results

Fifty-five patients (mean age, 66 years; male-to-female ratio, 8:1) were included in the study. Previous treatments were RT in 22 (40%) patients, CRT in 21 (38.2%), and partial laryngeal surgery followed by adjuvant (C)RT in 12 (21.8%). Reconstruction was accomplished by radial forearm and anterolateral thigh free flaps in 16 (29.1%) and 39 (70.9%) patients, respectively. Flap success rate was 98.2%. Concerning postoperative complications, we encountered 3 PCFs (5.4%) and 1 PES (1.8%).

Conclusion

The standardized reconstructive protocol analyzed herein granted significantly lower rates of PCF and PES after STL compared with data available in the literature.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS National Cancer Institute of Milan, Milan, Italy

    Cesare Piazza, Lorenzo Bresciani, Lorenzo Giannini, Fabiola Incandela & Walter Fontanella

  2. Department of Oncology and Oncohematology, University of Milan, Milan, Italy

    Cesare Piazza

  3. Department of Otorhinolaryngology - Head and Neck Surgery, Spedali Civili of Brescia, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy

    Alberto Paderno, Francesca Del Bon & Alberto Grammatica

  4. Department of Otorhinolaryngology - Head and Neck Surgery, University of Padua, Padua, Italy

    Nausica Montalto & Piero Nicolai

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  1. Cesare Piazza
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  2. Alberto Paderno
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  3. Francesca Del Bon
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  10. Piero Nicolai
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Correspondence to Alberto Paderno.

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Piazza, C., Paderno, A., Del Bon, F. et al. Fascio-cutaneous-free flaps as primary reconstruction in salvage total laryngectomy. Eur Arch Otorhinolaryngol 278, 219–226 (2021). https://doi.org/10.1007/s00405-020-06137-x

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