We appreciate the commentary by Reece and colleagues about our article, and we would like to address some of the issues they raised. They stated that "speech and swallowing are not the only factors that must be considered" and that providing "an expedient and reliable form of wound closure that avoids fistulae" is the first and foremost goal. Obviously, we agree with Reece et al with regard to the first and foremost goal of wound closure. However, we contend that understanding the effects of surgical reconstruction on speech and swallowing is a valid and important objective. The authors also agreed with our conclusion that primary closure is preferable with their statement, "If the wound can be closed by primary closure and a good postoperative outcome is expected with this form of closure, then primary closure should be performed." We also observed, as indicated below, that the fistula rate was less in patients who underwent primary closure, so we are not selectively excluding from the primary closure group an excess of patients whose condition has a potentially poorer prognosis. In our experience, larger lesions can be closed primarily without an increase in complications, and our data on fistula rates in primary closure support this experience.
Fred M. S. McConnel, Alfred W. Rademaker, Barbara Roa Pauloski, Laura A. Colangelo, Jerilyn A. Logemann. Functional Results After Oropharyngeal Reconstruction: A Different Perspective. Arch Otolaryngol Head Neck Surg. 1999;125(4):476–477. doi: