Prevention of postlaryngectomy pharyngocutaneous fistula: The memorial university experience

Objectives: The purpose of this study was to compare the efficacy of a pectoralis major myogenous flap in the prevention of pharyngocutaneous fistula in patients who have undergone total laryngectomy. Our secondary objective was to estimate the economic saving to our health care system. Design: Retrospective clinical study. Setting: Grace General Hospital, St. Clare's Mercy Hospital, H. Bliss Murphy Cancer and Research Centre, St. John's, Newfoundland. Materials and Methods: Two hundred and twenty-three consecutive total laryngectomy procedures performed between June 1978 and December 2001 were reviewed. The fistula rate in laryngectomy patients prior to 1988 without pectoralis major myogenous flaps (group A) was compared with that of patients after June 1988 who had this flap routinely used at primary surgery (group B). Analysis of risk factors within those two groups was essentially similar. Results: In group A, the overall pharyngocutaneous fistula rate was 22.9 %. The fistula rate in group B was less than 1 %. Conclusion: Our study has demonstrated that at our tertiary care head and neck oncology centre, we have dramatically decreased the incidence of postlaryngectomy pharyngocutaneous fistula. By the routine addition of a pectoralis major myogenous flap to cover the pharyngeal defect at surgery, we have substantially and dramatically reduced patient morbidity and mortality and reduced hospital stay, with major financial savings to the health care system.