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Patel et al1 present a multicenter study of postoperative fistula occurrence following salvage total laryngectomy. Their data demonstrate a significant reduction in fistula rates with either cutaneous free flap reconstruction of the pharyngeal defect or primary closure reinforced by a pectoralis major muscle pedicled flap. Moreover, in patients who experienced a fistula, the time to healing was reduced in both the free flap group and the pectoralis major flap group, which had the fastest healing time as well as the lowest rate of fistula formation.
Hanasono MM. Use of Reconstructive Flaps Following Total Laryngectomy. JAMA Otolaryngol Head Neck Surg. 2013;139(11):1163. doi:10.1001/jamaoto.2013.2768