Salvage Laryngectomy With Primary Pharyngeal Closure and Flap Onlay Technique

OBJECTIVE: Salvage laryngectomy is associated with significant reconstructive challenges related to pharyngocutaneous fistula (PCF) formation and need for secondary reconstruction. This retrospective study evaluates these surgical outcomes by comparing free flap onlay technique with pedicled muscle and fascial flap onlay technique. METHODS: All patients underwent chemoradiation therapy with recommendations for salvage laryngectomy after being diagnosed with recurrent or persistent laryngeal malignant disease. Patients were excluded if the surgical defect required interposed flap tissue for pharyngeal closure. Subgroup analysis was performed to compare overall rates of fistula and need for secondary reconstructive surgery. RESULTS: A significant overall association (p = 0.014) between flap reconstruction type and presence of PCF was found. The odds of fistula formation was 55% lower in the pedicled pectoralis/latissimus muscle flap group and 70% lower for the free flap reconstruction group compared to the reference group that underwent only primary pharyngeal closure, without flap onlay (odds ratio = 0.3, p = 0.004). CONCLUSION: PCF rates and need for secondary reconstructive efforts are decreased when free tissue onlay is employed to reinforce the pharyngeal closure line compared to pedicled flaps.