Outcomes in Salvage Laryngectomy with Free Tissue Transfer

Abstract

Objective: 1) Report the incidence of complications and feeding outcomes in salvage laryngectomy performed with free tissue transfer compared to primary closure. 2) Evaluate factors that may be associated with an increased rate of complications.

Method: Retrospective case series from a single institution between 2007 to 2012. Thirty-two patients met the following inclusion criteria: patients undergoing salvage laryngectomy with primary wound closure (16 patients) and those patients undergoing salvage laryngectomy with wound closure augmentation by microvascular free tissue transfer (16 patients).

Results: We performed a retrospective case series comparing complications in salvage laryngectomy closed primarily vs repair with free tissue transfer. Smoking status at surgery was similar between the 2 groups. In the primary closure group we report major fistula in 37.5%, minor fistula in 19%, dysphagia requiring dilatation in 25%, and feeding tube dependence in 14% of patients. In the free tissue transfer group we report major fistula formation in 12.5%, dysphagia requiring dilatation in 12.5%, and feeding tube dependence in 8% of patients. Minor fistula did not occur in the free tissue transfer group.

Conclusion: Multiple factors were compared and preliminary data suggests that free tissue transfer reduces major and minor fistula rates. Additionally, fewer patients required dilatation and fewer patients were feeding tube–dependent in the free tissue transfer group. Formal statistical analysis will be performed.