{"title":"喉切除术和放疗后的咽喉瘤重建:回顾性研究与文献综述。","authors":"","doi":"10.1016/j.bjps.2024.10.019","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The occurrence of pharyngocutaneous fistula or pharyngostoma after oncologic head and neck surgery is a serious complication. It is the most common complication after major hypopharyngeal and laryngeal ablative surgery.</div></div><div><h3>Aim</h3><div>The purpose of this study is to review the surgical approach and evaluate the results regarding reconstruction methods of pharyngostoma, caused after laryngectomy and radiotherapy.</div></div><div><h3>Patients and methods</h3><div>The total number of patients is 15. Pharyngostoma caused swallowing difficulties, as well as frequent aspiration pneumonia. The intervention interval from laryngectomy to pharyngeal reconstruction varied between one and three years, depending on the severity of symptoms and after the complete failure of conservative rehabilitation methods. Pharyngostoma reconstruction was performed mainly with pectoralis major myocutaneous flap in 11 cases. The radial forearm free flap and the anterolateral thigh free flap were also used in the remaining four cases.</div></div><div><h3>Results</h3><div>The post-operative course was uncomplicated, and in most cases, the feeding with soft food started after a barium meal between 15 and 20 days post-operatively. Complications include wound dehiscence and leak treated conservatively and one case of carotid rupture.</div></div><div><h3>Conclusions</h3><div>The gold standard for pharyngostoma reconstruction, after laryngectomy and cervical radiotherapy, remains the use of pectoralis major myocutaneous flap. In cases of extensive neck radionecrosis, free flaps are preferable. Reliable and stable cover of the large vessels of the neck, along with the reconstruction of the digestive tract and the restoration of swallowing function are issues that are analysed in correlation with the avoidance of stenosis and swallowing difficulties.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0000,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Pharyngostoma reconstruction after laryngectomy and radiotherapy: A retrospective study and literature review\",\"authors\":\"\",\"doi\":\"10.1016/j.bjps.2024.10.019\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>The occurrence of pharyngocutaneous fistula or pharyngostoma after oncologic head and neck surgery is a serious complication. It is the most common complication after major hypopharyngeal and laryngeal ablative surgery.</div></div><div><h3>Aim</h3><div>The purpose of this study is to review the surgical approach and evaluate the results regarding reconstruction methods of pharyngostoma, caused after laryngectomy and radiotherapy.</div></div><div><h3>Patients and methods</h3><div>The total number of patients is 15. Pharyngostoma caused swallowing difficulties, as well as frequent aspiration pneumonia. The intervention interval from laryngectomy to pharyngeal reconstruction varied between one and three years, depending on the severity of symptoms and after the complete failure of conservative rehabilitation methods. Pharyngostoma reconstruction was performed mainly with pectoralis major myocutaneous flap in 11 cases. The radial forearm free flap and the anterolateral thigh free flap were also used in the remaining four cases.</div></div><div><h3>Results</h3><div>The post-operative course was uncomplicated, and in most cases, the feeding with soft food started after a barium meal between 15 and 20 days post-operatively. Complications include wound dehiscence and leak treated conservatively and one case of carotid rupture.</div></div><div><h3>Conclusions</h3><div>The gold standard for pharyngostoma reconstruction, after laryngectomy and cervical radiotherapy, remains the use of pectoralis major myocutaneous flap. In cases of extensive neck radionecrosis, free flaps are preferable. Reliable and stable cover of the large vessels of the neck, along with the reconstruction of the digestive tract and the restoration of swallowing function are issues that are analysed in correlation with the avoidance of stenosis and swallowing difficulties.</div></div>\",\"PeriodicalId\":50084,\"journal\":{\"name\":\"Journal of Plastic Reconstructive and Aesthetic Surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2024-10-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Plastic Reconstructive and Aesthetic Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1748681524006636\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Plastic Reconstructive and Aesthetic Surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1748681524006636","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
Pharyngostoma reconstruction after laryngectomy and radiotherapy: A retrospective study and literature review
Background
The occurrence of pharyngocutaneous fistula or pharyngostoma after oncologic head and neck surgery is a serious complication. It is the most common complication after major hypopharyngeal and laryngeal ablative surgery.
Aim
The purpose of this study is to review the surgical approach and evaluate the results regarding reconstruction methods of pharyngostoma, caused after laryngectomy and radiotherapy.
Patients and methods
The total number of patients is 15. Pharyngostoma caused swallowing difficulties, as well as frequent aspiration pneumonia. The intervention interval from laryngectomy to pharyngeal reconstruction varied between one and three years, depending on the severity of symptoms and after the complete failure of conservative rehabilitation methods. Pharyngostoma reconstruction was performed mainly with pectoralis major myocutaneous flap in 11 cases. The radial forearm free flap and the anterolateral thigh free flap were also used in the remaining four cases.
Results
The post-operative course was uncomplicated, and in most cases, the feeding with soft food started after a barium meal between 15 and 20 days post-operatively. Complications include wound dehiscence and leak treated conservatively and one case of carotid rupture.
Conclusions
The gold standard for pharyngostoma reconstruction, after laryngectomy and cervical radiotherapy, remains the use of pectoralis major myocutaneous flap. In cases of extensive neck radionecrosis, free flaps are preferable. Reliable and stable cover of the large vessels of the neck, along with the reconstruction of the digestive tract and the restoration of swallowing function are issues that are analysed in correlation with the avoidance of stenosis and swallowing difficulties.
期刊介绍:
JPRAS An International Journal of Surgical Reconstruction is one of the world''s leading international journals, covering all the reconstructive and aesthetic aspects of plastic surgery.
The journal presents the latest surgical procedures with audit and outcome studies of new and established techniques in plastic surgery including: cleft lip and palate and other heads and neck surgery, hand surgery, lower limb trauma, burns, skin cancer, breast surgery and aesthetic surgery.