Laryngeal and Pharyngeal Reconstruction: A Worldwide Review of the Current Guidelines and Standards of Practice. Does a Universal Reconstruction Algorithm Exist?

Abstract

Introduction: The reconstruction of hypopharynx and larynx post ablative surgery has been always a demanding challenge. Not only the restoration of the anatomy and achieving robust wound healing, but also the complexity of function in the area for the airway and upper digestive tract not to be compromised. Moreover, the age of this group of patients and perioperative radiotherapy adds to the existing obstacles in reconstruction. The evolution of microsurgery and free tissue transfer replacing the previous gold standard pedicled flaps revolutionized the head and neck reconstruction. It became a necessity to elicit how far the head and neck reconstruction practice has gone around the globe and what is considered the gold standard technique for reconstruction of each of the defects encountered at the present time. We performed a systematic review appraising the current head and neck reconstruction practice around the world aiming at concluding the gold standard methods of reconstruction of the defects in this area. Methods: Search strategy: Medline using the PubMed interface on 1st of October 2020. Results and search outcome: 236 papers were found. Of which 66 publications in the last 10 years were shortlisted reflecting the most recent practice. 20 of these were identified addressing the reconstructive approach Figure 1. Conclusions: Various reconstructive methods are reliably used in certain indications with comparable results around the globe. We present an unprecedented evidence-based universal algorithm for post ablative surgery reconstruction for the laryngeal and pharyngeal defects.