Objective:
To compare the difference of using skin or ileocolon flap for voice reconstruction.
Voice restoration improves hypopharyngeal cancer patients’ quality of life after receiving total pharyngolaryngectomy. In this study, we analyzed and compared the results of voice reconstruction using ileocolon or skin flap (including radial forearm flap, and anterolateral flap.).
Materials and Methods
PubMed, Embase, and Google Scholar databases were searched for reviews on reconstruction of cervical esophagus and voice reconstruction after total pharyngolaryngecomy. Fourty-two studies were selected initially. After deduplicated, screened, and assessed for eligibility, 12 studies were chosen for systematic review followed by further analysis and comparison.
Results
Among the fourteen studies chosen for the systematic review, there were 297 cases of ileocolon and 147 cases of skin flaps. The average follow-up period in this systematic review was 21.99 months, ranging from 1 to 72 months. Speech intelligibility was recorded and measured by maximal phonation time (MPT), frequency, loudness, and 5-point Likert scale. The complications of both donor site and recipient site were also documented. We also presented a case from the database of our institution to demonstrate the voice reconstruction using ileocolon flap. Regarding complications of the operation, skin flap had higher complication rate than ileocolon flap when comparing the chance of obstruction at the junction of voice tube and esophagus (15.95% vs. 0.32%), risk of aspiration pneumonia (12.15% vs. 2.11%), chronic inflammation in the voice tube, and leakage rate (29.19% vs. 0.73%). The analysis of 5-point Likert scale for speech intelligibility also indicated that ileocolon flap showed better voice quality (mostly >9) than skin flap (3.48). There was no significant difference in MPT between ileocolon flap and skin flap (10.00 vs. 7.97 seconds). Ileocolon voice tended to produce a lower-pitched voice (114.80 Hz) and quieter voice (59.05 dB) while voice reconstruction with skin flap tended to have a higher-pitched voice (143.91 Hz) and louder voice (61.98 dB).
Conclusions
The systematic review indicated that when comparing voice reconstruction, patients with ileocolon flap showed better voice quality than those who underwent reconstruction with skin flap. Those who received ileocolon flap showed fewer complications such as leakage rate, aspiration pneumonia, and obstruction. Thus, their quality of life was higher. For better voice quality, we had to minimize the regurgitation rate for the prevention of aspiration pneumonia and achieve better voice outcome. In ileocolon flap reconstruction, we plicated the ileocecal valve to 0.5 cm in diameter to prevent regurgitation of food or saliva into airway.
The only concern was that procedures of intestinal flap surgery was more complicated and difficult to perform, thus the operation had to be carried out by experienced surgeons.

Download