A comparison between free gracilis muscle flap and pedicled pectoralis major flap reconstructions following salvage laryngectomy

作者：Jing Shan Shan^*; O'Neill Trevor; Clibbon Jonothan J

来源：Journal of Plastic Reconstructive and Aesthetic Surgery, 2014, 67(1): 17-22.

DOI：10.1016/j.bjps.2013.08.018

• Fistula
• Pectoralis major
• Laryngectomy
• Radiorecurrent
• Gracilis

Introduction: Muscle flaps are often used in the prevention and treatment of pharyngocutaneous fistula following total salvage laryngectomy in the setting of chemo-radiated neck for laryngeal carcinomas. We report our experience with the gracilis free muscle flap compared to the pedicled pectoralis major for the prophylaxis of fistula formation.
Methods: Forty-nine patients with radio-recurrent laryngeal carcinoma over ten years who underwent salvage laryngectomy and either immediate free gracilis (22 patients) or pedicled pectoralis major muscle flap (27 patients) reconstruction were reviewed.
Results: There were 12 complications in pectoralis major flap group and eight in gracilis flap group. Most of these occurred early in the post-operative period. These were related to poor wound healing with the pectoralis major flap reconstructions. Fistulation rates were similar in the two groups (Pectoralis major: 6/27, gracilis: 5/22).
Conclusions: In our experience, the gracilis free muscle flap is a good reconstructive option in the prevention of pharyngocutaneous fistula formation following salvage laryngectomies. It is at least equivalent to a pectoralis muscle flap in the prevention of fistulae, but we prefer the gracilis for many reasons, including ease of harvest and preservation of the pectoralis major flap for future reconstructions.

• 出版日期2014-1