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Head and Neck Surgery

Patient Outcomes in Total Laryngectomy With Pectoralis Flap vs Free Flap

Tuesday, October 3, 2023
3:36 PM - 3:42 PM East Coast USA Time
Location: 201AB

    Presenting Author(s)

  • NF

    Neil B. Fadia, BS

    Research Fellow
    University of Pittsburgh Medical Center
    Pittsburgh, Pennsylvania, United States

    • Co-Author(s)

  • SL

    Shirley X. Liu, MS

    Medical Student
    University of Pittsburgh School of Medicine
    Pittsburgh, PA, United States

  • MK

    Mark W. Kubik, MD

    Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh School of Medicine, USA

  • MS

    Mario G. Solari, MD

    Chief, H&N Reconstruction and Craniofacial Trauma
    University of Pittsburgh Medical Center, Department of Plastic Surgery
    Pittsburgh, PA, United States

    • Senior Author(s)

  • SS

    Shaum S. Sridharan, MD

    Assistant Professor, Department of Otolaryngology and Plastic & Reconstructive Surgery
    Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center
    Pittsburgh, PA, United States

Disclosure(s):
Neil Fadia, BS: No relevant relationships to disclose.
Introduction: Pharyngeal reconstruction is critical for re-establishing the alimentary tract after total laryngectomy. Recently, microvascular free flap reconstruction (MVFF) has become the more common reconstructive technique compared to the pectoralis major regional flap (PF). However, there is a paucity of comparative data in patient outcomes between the reconstructive modalities. This study aims to compare the two approaches in terms of post-operative and functional outcomes.

Methods: A retrospective review of patients undergoing reconstructive total laryngectomy from 2013 to 2019 was performed, and pertinent patient data was collected. Exclusion criteria included patients undergoing laryngectomies with primary closures or total laryngopharyngectomies. Primary post-operative outcomes of interest were length of stay (LOS), fistula rates, Clavien-Dindo grade 3/4 complications, and 30-day re-admission rates. Primary functional outcomes of interest were tracheoesophageal speech intelligibility (TSI), and voice quality with a tracheoesophageal voice prosthesis. Speech and voice quality were graded by speech pathologists. Analyses were performed using pairwise comparisons and Mann-Whitney U tests.

Results: 132 total patients (52 MVFF, and 80 PF) were identified, with 45.7% being male, and an average age of 61.2 + 9.7 years. The difference in LOS (MVFF: 10.6 days; PF: 10.9 days) and fistula rates (MVFF: 17.3%; PF: 26.3%) was not significant. There were also no significant differences in severe complications (MVFF: 21.2%; PF: 18.8%) and 30-day re-admissions (MVFF: 31.0%; PF: 40.0%). In functional outcomes, the PF group scored significantly worse in TSI (MVFF: 1.79; PF: 2.81; p= 0.006) and voice quality (MVFF: 2.02; PF: 3.36; p=0.027).

Conclusions: Post-laryngectomy microvascular reconstruction appears to have comparable post-operative outcomes in LOS, fistula rate, and severe complications to the pectoralis major flap. Patient in this cohort undergoing free flap reconstruction appear to have improved tracheoesophageal voice production and speech quality compared to those with pectoralis major flap.