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Gil Z, Gupta A, Kummer B, et al. The Role of Pectoralis Major Muscle Flap in Salvage Total Laryngectomy. Arch Otolaryngol Head Neck Surg. 2009;135(10):1019–1023. doi:https://doi.org/10.1001/archoto.2009.126
To assess the utility of the pectoralis major muscle flap (PMMF) in patients undergoing salvage total laryngectomy.
Retrospective cohort analysis.
Tertiary care cancer center.
The study included 461 patients who underwent laryngectomy. Eighty of them underwent salvage surgery with primary pharyngeal closure.
Of the 80 patients, 69 (86%) underwent primary pharyngeal closure alone and 11 (14%) underwent a PMMF, which was used to buttress the pharyngeal suture line.
Main Outcome Measure
Two hundred thirty-six variables were recorded for each patient. Complications related to pharyngeal closure were measured.
Sixty-four percent of the patients who underwent PMMF also underwent chemoradiation therapy as the initial definitive treatment compared with 25% in the non-PMMF group (P = .03). On multivariate analysis, chemoradiation therapy was the only independent predictor of pharyngocutaneous fistula formation (relative risk, 1.82; P = .02). Nevertheless, the pharyngocutaneous fistula rate was similar in the PMMF (27%) and the non-PMMF (24%) groups. Furthermore, similar durations of tube feeding, days to oral feeding, and hospitalization period were recorded in both groups.
The PMMF should be used judiciously as a surgical adjunct in high-risk patients, with the goal of minimizing the risk for the development of a pharyngocutaneous fistula.
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