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Article: Reconstruction of circumferential pharyngeal defects after tumour resection: Reference or preference

TitleReconstruction of circumferential pharyngeal defects after tumour resection: Reference or preference
Authors
KeywordsAnterolateral thigh flap
Circumferential pharyngectomy
Jejunal flap
Leakage
Pectoralis major flap
Stricture
Issue Date2011
PublisherChurchill Livingstone. The Journal's web site is located at http://www.elsevier.com/wps/find/journaldescription.cws_home/707671/description#description
Citation
Journal Of Plastic, Reconstructive And Aesthetic Surgery, 2011, v. 64 n. 8, p. 1022-1029 How to Cite?
AbstractBackground: Reconstruction of circumferential hypopharyngeal defects is often challenging. The aim of the study is to examine the result of our experience and to formulate improved management guidelines. Method: Between 1980 and 2009, all patients who have circumferential pharyngectomy were recruited. Data were recorded prospectively for analysis. Results: A total of 202 patients were recruited. Majority had primary tumour in the hypopharynx (n = 165), and the remaining patients had recurrent laryngeal carcinoma. Radiotherapy was given preoperatively in 72 patients and postoperatively in 108 patients. A pectoralis major (PM) flap was used in 92 (45.5%) patients, a free anterolateral thigh (ALT) flap in 24 (11.9%) patients and a free jejunal flap in 86 (42.6%) patients. Early fistula rate was 23.9% in the PM flap group, 12.5% in the ALT group and 4.6% in the jejunum group. Late anastomotic stricture rate was 27.2% in the PM flap group, 12.5% in the free ALT group and 2.3% in the jejunum group. Early fistula formation significantly increased the risk of subsequent anastomotic stricture (p = 0.023). In patients with no stricture, 61.9% of them in the jejunal group were able to resume solid diet, compared with 35.8% and 38.1% in the PM and ALT groups. After PM flap harvesting, 34.8% of the chest wall defects could not be closed primarily, which were best repaired using the lateral thoracic flap. The donor-site morbidity of ALT and jejunal flap was low. Conclusion: In suitable patients, free jejunal flap reconstruction of circumferential pharyngectomy defects achieves the best functional outcome with minimal donor-site morbidity. © 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons.
Persistent Identifierhttp://hdl.handle.net/10722/137550
ISSN
2015 Impact Factor: 1.743
2015 SCImago Journal Rankings: 0.974
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorChan, YWen_HK
dc.contributor.authorNg, RWMen_HK
dc.contributor.authorLun Liu, LHen_HK
dc.contributor.authorChung, HPen_HK
dc.contributor.authorWei, WIen_HK
dc.date.accessioned2011-08-26T14:27:51Z-
dc.date.available2011-08-26T14:27:51Z-
dc.date.issued2011en_HK
dc.identifier.citationJournal Of Plastic, Reconstructive And Aesthetic Surgery, 2011, v. 64 n. 8, p. 1022-1029en_HK
dc.identifier.issn1748-6815en_HK
dc.identifier.urihttp://hdl.handle.net/10722/137550-
dc.description.abstractBackground: Reconstruction of circumferential hypopharyngeal defects is often challenging. The aim of the study is to examine the result of our experience and to formulate improved management guidelines. Method: Between 1980 and 2009, all patients who have circumferential pharyngectomy were recruited. Data were recorded prospectively for analysis. Results: A total of 202 patients were recruited. Majority had primary tumour in the hypopharynx (n = 165), and the remaining patients had recurrent laryngeal carcinoma. Radiotherapy was given preoperatively in 72 patients and postoperatively in 108 patients. A pectoralis major (PM) flap was used in 92 (45.5%) patients, a free anterolateral thigh (ALT) flap in 24 (11.9%) patients and a free jejunal flap in 86 (42.6%) patients. Early fistula rate was 23.9% in the PM flap group, 12.5% in the ALT group and 4.6% in the jejunum group. Late anastomotic stricture rate was 27.2% in the PM flap group, 12.5% in the free ALT group and 2.3% in the jejunum group. Early fistula formation significantly increased the risk of subsequent anastomotic stricture (p = 0.023). In patients with no stricture, 61.9% of them in the jejunal group were able to resume solid diet, compared with 35.8% and 38.1% in the PM and ALT groups. After PM flap harvesting, 34.8% of the chest wall defects could not be closed primarily, which were best repaired using the lateral thoracic flap. The donor-site morbidity of ALT and jejunal flap was low. Conclusion: In suitable patients, free jejunal flap reconstruction of circumferential pharyngectomy defects achieves the best functional outcome with minimal donor-site morbidity. © 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons.en_HK
dc.languageengen_US
dc.publisherChurchill Livingstone. The Journal's web site is located at http://www.elsevier.com/wps/find/journaldescription.cws_home/707671/description#descriptionen_HK
dc.relation.ispartofJournal of Plastic, Reconstructive and Aesthetic Surgeryen_HK
dc.subjectAnterolateral thigh flapen_HK
dc.subjectCircumferential pharyngectomyen_HK
dc.subjectJejunal flapen_HK
dc.subjectLeakageen_HK
dc.subjectPectoralis major flapen_HK
dc.subjectStrictureen_HK
dc.subject.meshAnastomosis, Surgical - adverse effects-
dc.subject.meshHypopharyngeal Neoplasms - surgery-
dc.subject.meshLaryngeal Neoplasms - surgery-
dc.subject.meshPharyngectomy-
dc.subject.meshSurgical Flaps-
dc.titleReconstruction of circumferential pharyngeal defects after tumour resection: Reference or preferenceen_HK
dc.typeArticleen_HK
dc.identifier.emailChan, YW: jywchan1@hku.hken_HK
dc.identifier.emailWei, WI: hrmswwi@hku.hken_HK
dc.identifier.authorityChan, YW=rp01314en_HK
dc.identifier.authorityWei, WI=rp00323en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.bjps.2011.03.021en_HK
dc.identifier.pmid21481656-
dc.identifier.scopuseid_2-s2.0-79960847193en_HK
dc.identifier.hkuros190786en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-79960847193&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume64en_HK
dc.identifier.issue8en_HK
dc.identifier.spage1022en_HK
dc.identifier.epage1029en_HK
dc.identifier.isiWOS:000293009100017-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridChan, YW=27171772200en_HK
dc.identifier.scopusauthoridNg, RWM=7102153861en_HK
dc.identifier.scopusauthoridLun Liu, LH=37075178000en_HK
dc.identifier.scopusauthoridChung, HP=54083018800en_HK
dc.identifier.scopusauthoridWei, WI=7403321552en_HK

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