CLINICAL APPLICATION OF PEDICLED THORACOACROMIAL ARTERY PERFORATOR FLAP FOR PHARYNGOCUTANEOUS FISTULA REPAIR AFTER RADIOTHERAPY AND SALVAGE TOTAL LARYNGECTOMY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SONGDajiang ¹ ,  LIZan ¹ , ZHOUXiao ¹ , ZHANGYixin ² , PENGXiaowei ¹ , ZHOUBo ¹ , LÜChunliu ¹ , YANGLichang ¹ , PENGWen ¹

1. Department of Tumor Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P. R. China;
2. Department of Plastic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine;

Corresponding author：

LIZan, Email: zzanli@163.com

Keywords：

Thoracoacromial artery; Perforator flap; Repair; Total laryngectomy; Pharyngocutaneous fistula

DOI：

10.7507/1002-1892.20160255

Video：

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Objective To explore the effectiveness of pedicled thoracoacromial artery perforator (TAAP) flap for pharyngocutaneous fistula repair after total laryngectomy and radiotherapy. Methods Between February 2012 and January 2015, TAAP flap was used to repair pharyngocutaneous fistula after total laryngectomy and radiotherapy in 8 patients. The eight patients were male, aged from 46 to 72 years (mean, 51.8 years). The disease duration was 8-62 months (mean, 27.5 months). Fistula size ranged from 4.0 cm×2.5 cm to 6.0 cm×4.0 cm and the skin defect size ranged from 4.0 cm×3.0 cm to 6.0 cm×4.0 cm. The flap size ranged from 7.0 cm×4.0 cm×0.3 cm to 9.5 cm×6.0 cm×0.5 cm. The length of pedicle was (8.3±0.5)mm. The distance from pivot point of flap to central point of recipient site was (94.5±1.9) mm. Results All 8 flaps survived and all incisions healed smoothly. The hospitalization time was 7-14 days (mean, 9.6 days). The barium meal examination showed no fistula or stenosis. The patients were followed up 8-42 months (mean, 28.5 months). During follow-up, the neck appearance was good, and no fistulas or stenosis occurred. Only linear scars were observed at the donor sites, pectoralis major muscle function was normal in all patients. Conclusion Pharyngocutaneous fistula should be repaired as early as possible after total laryngectomy. TAAP flap is suitable for the reconstruction of pharyngocutaneous fistula after total laryngectomy.

Citation： SONG Dajiang, LI Zan, ZHOU Xiao, ZHANG Yixin, PENG Xiaowei, ZHOU Bo, LÜ Chunliu, YANG Lichang, PENG Wen. CLINICAL APPLICATION OF PEDICLED THORACOACROMIAL ARTERY PERFORATOR FLAP FOR PHARYNGOCUTANEOUS FISTULA REPAIR AFTER RADIOTHERAPY AND SALVAGE TOTAL LARYNGECTOMY. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(10): 1249-1252. doi: 10.7507/1002-1892.20160255 Copy

1.	Khandavilli S, Kamisetty A, Paley M, et al. Life-threatening hyponatremia secondary to an orocutaneous fistula. J Oral Maxillofac Surg, 2009, 67(5):1132-1135.
2.	Olasz L, Németh A, Nyárády Z. Surgical closures of oropharyngocutaneous fistulas. Plast Reconstr Surg, 2000, 106(7):1577-1581.
3.	周晓, 胡炳强, 罗以. 浅谈肿瘤整形外科形成的必要性. 中国肿瘤, 2001, 10(12):694-695.
4.	Reece GP, Schusterman MA, Miller MJ, et al. Morbidity and functional outcome of free jejunal transfer reconstruction for circumferential defects of the pharynx and cervical esophagus. Plast Reconstr Surg, 1995, 96(6):1307-1316.
5.	No authors listed. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. The Department of Veterans Affairs Laryngeal Cancer Study Group. N Engl J Med, 1991, 324(24):1685-1690.
6.	León X, Quer M, Orús C, et al. Results of salvage surgery for local or regional recurrence after larynx preservation with induction chemotherapy and radiotherapy. Head Neck, 2001, 23(9):733-738.
7.	McCombe AW, Jones AS. Radiotherapy and complications of laryngectomy. J Laryngol Otol, 1993, 107(2):130-132.
8.	Lee DW, Chung S, Lee WJ, et al. Use of a collagen patch for management of pharyngocutaneous fistula after hypopharyngeal reconstruction. J Craniofac Surg, 2010, 21(6):1674-1676.
9.	Sharon-Buller A, Sela M. An acrylic resin prosthesis for obturation of an orocutaneous fistula. J Prosthet Dent, 2007, 97(3):179-180.
10.	Karakullukcu MB, Lohuis PJ, van den Brekel MW, et al. Sealing of small postlaryngectomy pharyngocutaneous fistulas with voice prosthesis. Laryngoscope, 2010, 120(10):1971-1973.
11.	Demir Z, Velidedeoğlu H, Celebioğlu S. Repair of pharyngocutaneous fistulas with the submental artery island flap. Plast Reconstr Surg, 2005, 115(1):38-44.
12.	Liu HL, Chan JY, Wei WI. The changing role of pectoralis major flap in head and neck reconstruction. Eur Arch Otorhinolaryngol, 2010, 267(11):1759-1763.
13.	Balakrishnan C, Narasimhan K, Gursel T, et al. Closure of orocutanous fistula using a pedicled expanded deltopectoral flap. Can J Plast Surg, 2008, 16(3):178-180.
14.	Song M, Chen SW, Zhang Q, et al. External monitoring of buried radial forearm free flaps in hypopharyngeal reconstruction. Acta Otolaryngol, 2011, 131(2):204-209.
15.	Pirgousis P, Fernandes R. Use of the internal mammary artery perforator flap for repair of pharyngocutaneous fistulas in the vessel-depleted neck. J Oral Maxillofac Surg, 2011, 69(4):1225-1228.
16.	McCarthy CM, Kraus DH, Cordeiro PG. Tracheostomal and cervical esophageal reconstruction with combined deltopectoral flap and microvascular free jejunal transfer after central neck exenteration. Plast Reconstr Surg, 2005, 115(5):1304-1313.
17.	Disa JJ, Cordeiro PG. Reconstruction of the hypopharynx and cervical esophagus. Clin Plast Surg, 2001, 28(2):349-360.
18.	Reece GP, Bengtson BP, Schusterman MA. Reconstruction of the pharynx and cervical esophagus using free jejunal transfer. Clin Plast Surg, 1994, 21(1):125-136.
19.	Cristalli G, Pellini R, Roselli R, et al. Pectoralis major myocutaneous flap for hypopharyngeal reconstruction:long-term results. J Craniofac Surg, 2011, 22(2):581-584.
20.	Saussez S, Cuno A, Urbain F, et al. Reconstruction of circumferential oro- and hypopharyngeal defects with U-shaped pectoralis major myocutaneous flap. Otolaryngol Head Neck Surg, 2006, 134(5):823-829.
21.	Spriano G, Pellini R, Roselli R. Pectoralis major myocutaneous flap for hypopharyngeal reconstruction. Plast Reconstr Surg, 2002, 110(6):1408-1416.
22.	Zhang YX, Li Z, Grassetti L, et al. A new option with the pedicle thoracoacromial artery perforator flap for hypopharyngeal reconstructions. Laryngoscope, 2016, 126(6):1315-1320.
23.	Li Z, Cui J, Zhang YX, et al. Versatility of the thoracoacromial artery perforator flap in head and neck reconstruction. J Reconstr Microsurg, 2014, 30(7):497-503.
24.	Zhang YX, Yongjie H, Messmer C, et al. Thoracoacromial artery perforator flap:anatomical basis and clinical applications. Plast Reconstr Surg, 2013, 131(5):759e-770e.

1. Khandavilli S, Kamisetty A, Paley M, et al. Life-threatening hyponatremia secondary to an orocutaneous fistula. J Oral Maxillofac Surg, 2009, 67(5):1132-1135.
2. Olasz L, Németh A, Nyárády Z. Surgical closures of oropharyngocutaneous fistulas. Plast Reconstr Surg, 2000, 106(7):1577-1581.
3. 周晓, 胡炳强, 罗以. 浅谈肿瘤整形外科形成的必要性. 中国肿瘤, 2001, 10(12):694-695.
4. Reece GP, Schusterman MA, Miller MJ, et al. Morbidity and functional outcome of free jejunal transfer reconstruction for circumferential defects of the pharynx and cervical esophagus. Plast Reconstr Surg, 1995, 96(6):1307-1316.
5. No authors listed. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. The Department of Veterans Affairs Laryngeal Cancer Study Group. N Engl J Med, 1991, 324(24):1685-1690.
6. León X, Quer M, Orús C, et al. Results of salvage surgery for local or regional recurrence after larynx preservation with induction chemotherapy and radiotherapy. Head Neck, 2001, 23(9):733-738.
7. McCombe AW, Jones AS. Radiotherapy and complications of laryngectomy. J Laryngol Otol, 1993, 107(2):130-132.
8. Lee DW, Chung S, Lee WJ, et al. Use of a collagen patch for management of pharyngocutaneous fistula after hypopharyngeal reconstruction. J Craniofac Surg, 2010, 21(6):1674-1676.
9. Sharon-Buller A, Sela M. An acrylic resin prosthesis for obturation of an orocutaneous fistula. J Prosthet Dent, 2007, 97(3):179-180.
10. Karakullukcu MB, Lohuis PJ, van den Brekel MW, et al. Sealing of small postlaryngectomy pharyngocutaneous fistulas with voice prosthesis. Laryngoscope, 2010, 120(10):1971-1973.
11. Demir Z, Velidedeoğlu H, Celebioğlu S. Repair of pharyngocutaneous fistulas with the submental artery island flap. Plast Reconstr Surg, 2005, 115(1):38-44.
12. Liu HL, Chan JY, Wei WI. The changing role of pectoralis major flap in head and neck reconstruction. Eur Arch Otorhinolaryngol, 2010, 267(11):1759-1763.
13. Balakrishnan C, Narasimhan K, Gursel T, et al. Closure of orocutanous fistula using a pedicled expanded deltopectoral flap. Can J Plast Surg, 2008, 16(3):178-180.
14. Song M, Chen SW, Zhang Q, et al. External monitoring of buried radial forearm free flaps in hypopharyngeal reconstruction. Acta Otolaryngol, 2011, 131(2):204-209.
15. Pirgousis P, Fernandes R. Use of the internal mammary artery perforator flap for repair of pharyngocutaneous fistulas in the vessel-depleted neck. J Oral Maxillofac Surg, 2011, 69(4):1225-1228.
16. McCarthy CM, Kraus DH, Cordeiro PG. Tracheostomal and cervical esophageal reconstruction with combined deltopectoral flap and microvascular free jejunal transfer after central neck exenteration. Plast Reconstr Surg, 2005, 115(5):1304-1313.
17. Disa JJ, Cordeiro PG. Reconstruction of the hypopharynx and cervical esophagus. Clin Plast Surg, 2001, 28(2):349-360.
18. Reece GP, Bengtson BP, Schusterman MA. Reconstruction of the pharynx and cervical esophagus using free jejunal transfer. Clin Plast Surg, 1994, 21(1):125-136.
19. Cristalli G, Pellini R, Roselli R, et al. Pectoralis major myocutaneous flap for hypopharyngeal reconstruction:long-term results. J Craniofac Surg, 2011, 22(2):581-584.
20. Saussez S, Cuno A, Urbain F, et al. Reconstruction of circumferential oro- and hypopharyngeal defects with U-shaped pectoralis major myocutaneous flap. Otolaryngol Head Neck Surg, 2006, 134(5):823-829.
21. Spriano G, Pellini R, Roselli R. Pectoralis major myocutaneous flap for hypopharyngeal reconstruction. Plast Reconstr Surg, 2002, 110(6):1408-1416.
22. Zhang YX, Li Z, Grassetti L, et al. A new option with the pedicle thoracoacromial artery perforator flap for hypopharyngeal reconstructions. Laryngoscope, 2016, 126(6):1315-1320.
23. Li Z, Cui J, Zhang YX, et al. Versatility of the thoracoacromial artery perforator flap in head and neck reconstruction. J Reconstr Microsurg, 2014, 30(7):497-503.
24. Zhang YX, Yongjie H, Messmer C, et al. Thoracoacromial artery perforator flap:anatomical basis and clinical applications. Plast Reconstr Surg, 2013, 131(5):759e-770e.

Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL APPLICATION OF PEDICLED THORACOACROMIAL ARTERY PERFORATOR FLAP FOR PHARYNGOCUTANEOUS FISTULA REPAIR AFTER RADIOTHERAPY AND SALVAGE TOTAL LARYNGECTOMY

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