A Solution to Reduce Pharyngocutaneous Fistula in Patch Free Flap Reconstructions after Salvage Laryngectomies using Edge De-epithelialization

Nina Lanie C. Constantino1, Pi Chieh Lin2, Johnson Chia-Shen Yang2,3, Pao-Jen Kuo2,3, Yueh-Ju Tsai2, Ko-Chien Lin2, Yuan-Hao Yen2, Cen-Hung Lin2,3

1
2 Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan 83301
3 Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan 33302


Objective
A total laryngectomy for oropharyngeal or hypopharyngeal cancer would result in a pharyngoesophageal defect. The mainstay for reconstruction has been a fasciocutaneous free flap. The increasing pre-operative radiotherapy has brought the reconstruction more difficulty. We had been using a method called “edge de-epithelialization” to facilitate the tissue healings at our hospital. The aim was to compare the outcomes within cases adopting this method or not.

Material and Methods
We reviewed the medical records of patients having oropharyngeal and hypopharyngeal cancers and underwent a total laryngectomy and a following free fasciocutaneous flap reconstruction at our hospital in 10 years. Only those cases using patch design of the flap were included. Patients expired during the exact hospitalization were excluded. Patient characteristics including experience of pre-operative radiotherapy, size and area of the defects, flap choices were recorded. We also recorded the length of hospitalization after the operations and post-operative complications. Statistical analyses were performed for comparisons.

Results
Forty-one patients underwent a total laryngectomy and a following free fasciocutaneous flap using a patch design and concurrent edge de-epithelialization. On the other hand, 79 patients also had the same operations but without performing edge de-epithelialization. A significant lower rate of pharyngocutaneous fistula was noticed in the group adopting edge de-epithelialization (p value = 0.0145). This finding was also compatible in patients who had salvage total laryngectomies (p value = 0.0288).

Conclusions
We presented a simple but efficient method to facilitate the tissue healing after patch free flap reconstructions of pharyngoesophageal defects.

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