Table V.
Comparison of pharyngocutaneous fistula in patients with salvage laryngectomy with and without flap reinforcement. In two studies, besides for reinforcement, the flap was also used to reconstruct pharyngeal defects 21 23.
| Authors | Year | N | Site | Flap | Fistula | WC | Fistula No flap | WC No flap | p | Remarks |
|---|---|---|---|---|---|---|---|---|---|---|
| Righini 19 | 2005 | 60 | larynx larynx |
PMMF PMMF |
23% 13% |
50% 73% |
0.06 0.018 |
Radiotherapy Subgroup: diabetes mellitus, vascular history, poor nutritional status |
||
| Fung 20 | 2007 | 41 | larynx | FVT | 29% | 0% | 30% | 15% | n.s. | |
| Patel 6 | 2009 | 17 | larynx | PMF | 0% | 57% | 0.02 | (Chemo)radiotherapy | ||
| Gil 5 | 2009 | 80 | larynx | PMMF | 27% | 24% | n.s. | PMMF 64% CRT, nonPMMF 25% CRT | ||
| Smith 21 | 2003 | 223 | larynx | PMF | <1% | 23% | ||||
| Withrow 23 | 2007 | 37 | larynx | FRFF | 18% | 50% | FRFF 41%CRT, nonFRFF 35%CRT | |||
| Patel 9 | 2013 | 359 | larynx | PMF FVT |
15% 25% |
34% | 0.02 0.07 |
(Chemo)radiotherapy | ||
| Powell 52 | 2014 | 45 | larynx | FVT/PMF | 0% | 26% | ||||
| Sayles* 10 | 2014 | 33 studies | larynx | Onlay flap | 10% | 28% | 0.001 | (Chemo)radiotherapy | ||
| Paleri* 22 | 2014 | 591 | larynx | Pooled relative risk 0.63 (reduction one third compared to no flap) |
*
Systematic review;
WC: wound complications, p: p-value, PMMF: pectoralis major myofascial flap, FVT: free vascularised tissue, PMF: pectoralis major flap, FRFF: free radial forearm flap, CRT: chemoradiotherapy.