Ziegler Andrea, Pittman Amy, Thorpe Eric
Department of Otolaryngology, Loyola University Medical Center, Maywood, Illinois, USA.
Otolaryngol Head Neck Surg. 2021 Dec;165(6):827-829. doi: 10.1177/01945998211000424. Epub 2021 Mar 16.
After a salvage total laryngectomy, one of patients' primary goals is to resume oral intake. This retrospective chart review included all patients who underwent a salvage total laryngectomy with free or pedicled flap reconstruction to compare swallowing outcomes in those with an incorporated flap or primary pharyngeal closure with an onlay flap. There was no significant difference in the ability to achieve complete feeding tube independence or the time that it took to achieve independence. Patients with an onlay flap had significantly lower rates of subjective dysphagia and stricture as compared with patients with incorporated flaps. Incorporated fasciocutaneous flaps showed no significant difference from onlay flaps in terms of outcomes. However, incorporated musculocutaneous flaps showed higher rates of subjective dysphagia and stricture when compared with onlay flaps. Patients undergoing a salvage total laryngectomy and reconstruction with an onlay flap had significantly less postoperative dysphagia and stricture than patients with a musculocutaneous incorporated flap.
在挽救性全喉切除术后，患者的主要目标之一是恢复经口进食。这项回顾性病历审查纳入了所有接受带蒂或游离皮瓣重建的挽救性全喉切除术的患者，以比较采用内置皮瓣或咽壁一期关闭加用覆盖皮瓣患者的吞咽结果。在实现完全脱离鼻饲管的能力或实现这一目标所需的时间方面，没有显著差异。与采用内置皮瓣的患者相比，采用覆盖皮瓣的患者主观吞咽困难和狭窄的发生率显著更低。就结果而言，内置筋膜皮瓣与覆盖皮瓣没有显著差异。然而，与覆盖皮瓣相比，内置肌皮瓣的主观吞咽困难和狭窄发生率更高。接受挽救性全喉切除术并采用覆盖皮瓣重建的患者术后吞咽困难和狭窄明显少于采用内置肌皮瓣的患者。
