Does the use of the temporoparietal fascia free flap (TPFF) for pharyngeal closure reinforcement reduce the incidence of pharyngocutaneous fistula (PCF) in the salvage setting?
Background: PCF is a predictable complication of salvage total laryngectomy, with varying reported rates of 14 percent to 57 percent. In this study, the physicians used TPFF as an overlay technique to improve the nutritive healing bed and lessen the rate of PCF.
Setting: Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, London, Ontario, Canada; Liverpool and Wollongong Hospital, Wollongong, Australia.
Synopsis: The study analyzed 12 consecutive patients who underwent salvage laryngectomy not requiring pharyngeal resection. Once the tracheostomy was performed and the two-layer primary closure of the pharynx completed, the free flap was applied directly over the pharyngeal closure and tacked into position at three points, and its undersurface was sprayed with a film of tissue sealant adhesive. The buried flaps were monitored for seven days with Doppler probes with normal arterial and venous signal. All patients received a primary transesophageal puncture, and successful voicing with a tracheoesophageal puncture prosthesis was achieved in all patients. There were two minor complications—one wound hematoma and one partial dehiscence at the flap donor site—in two patients, but no further donor site complications. Only one patient (8 percent) of the 12 developed PCF. That patient was an active smoker.
Bottom line: The TPFF as an overlay technique is a useful adjunct for salvage laryngectomy cases that do not require pharyngeal mucosal replacement.
Reference: Higgins KM, Ashford B, Erovic BM, et al. Temporoparietal fascia free flap for pharyngeal coverage after total laryngectomy. Laryngoscope. 2012;33(12):523-527.