Prevention of postlaryngectomy pharyngocutaneous fistula using a sternocleidomastoid muscle collar flap

Objectives: The purpose of this study was to evaluate the efficacy of a sternocleidomastoid muscle collar flap in the prevention of pharyngocutaneous fistula in patients who had undergone total laryngectomy. Study design: Retrospective clinical study. Setting: Otolaryngology department, Tanta University, Egypt. Methods: Sixty-five consecutive total laryngectomy procedures performed between October 1999 and October 2005 were reviewed. The fistula rate in laryngectomy patients operated on prior to 2002, without sternocleidomastoid collar flap creation (group A) was compared with that of patients operated on after October 2002, at which time this flap was introduced for routine use during primary surgery (group B). Results: In group A, the incidence of pharyngocutaneous fistula was 12 in 35 (34 per cent) while its incidence in group B was 1 in 30 (3.3 per cent). On analysis, the risk factors within both the groups were essentially similar. Conclusion: The routine addition of a superiorly based sternal head of sternocleidomastoid muscle flap on one or both sides to cover the repaired pharynx during surgery reduced the incidence of postlaryngectomy pharyngocutaneous fistula, patient morbidity and mortality, and hospital stay; voice rehabilitation and swallowing were also improved.