Practical tips to reconstruct a total laryngectomy/partial pharyngectomy defect Book Section

  


Author: Kraus, D. H.
Editor: Cernea, C. R.
Article/Chapter Title: Practical tips to reconstruct a total laryngectomy/partial pharyngectomy defect
Abstract: The vast majority of patients who undergo laryngectomy with partial pharyngectomy represent chemoradiation failures. Thus, the vast majority of them will require flap reconstruction of the large soft tissue defect, which is associated with recurrent tumors in this setting. Even with the use of nonirradiated tissue transfer to close the defect, there is severe wound healing impairment, and many patients will develop a transient fistula. Extreme care must be taken in performing closure of the combined laryngectomy/partial pharyngectomy defect. Submucosal disease is extremely common and determination of reconstructive technique should not be performed until tumor-free margins have been obtained on frozen section. The ability to perform primary closure is extremely limited. Approximately 90-95% of patients will require a patch closure of the soft tissue defect. The decision to utilize a pectoralis flap versus a free tissue transfer will be based on a number of factors: expertise and preference of the reconstructive surgeon, patient comorbidities, and availability of donor free flap vessels. Despite all the described precautions, patients undergoing reconstruction of a laryngectomy/pharyngectomy defect remain at a high risk of fistula formation. Many of these fistulas will resolve with conservative management.
Keywords: Head surgery; Neck surgery; head and neck neoplasms surgery
Book Title: Pearls and Pitfalls in Head and Neck Surgery: Practical Tips to Minimize Complications. 1st ed
ISBN: 978-3-8055-8425-8
Publisher: S. Karger AG  
Publication Place: Basel, Switzerland
Date Published: 2008-01-01
Start Page: 94
End Page: 95
Language: English
PROVIDER: manual
Notes: Book Chapter: 5.2