Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Objectives: Reconstruction following laryngectomy poses significant challenges, especially in achieving successful healing and reducing complications. Preoperative sarcopenia may play a pivotal role in optimizing flap selection and improving functional outcomes postoperatively. This study investigates the association between preoperative cervical paraspinal muscle mass and the type of flap reconstruction in laryngectomy patients, and its influence on pharyngocutaneous fistula formation and tube feeding.
Methods: A retrospective cohort study of prospectively collected data from patients undergoing laryngectomy for cancer or a dysfunctional larynx at 3 academic institutions in North America. The study examined the relationship between preoperative cervical paraspinal muscle mass measured by CT at the C3 vertebra and the selected flap type, assessing outcomes including pharyngocutaneous fistula, length of stay and feeding tube dependence. Flap types were categorized into locoregional and free flaps, further divided into fasciocutaneous, myocutaneous, muscle-only, and chimeric components.
Results: Among the 62 patients who underwent laryngectomy, of which 59 were for cancer (21 hypopharynx and 38 larynx) and 3 for a dysfunctional larynx following previous treatment of head and neck cancer. The mean age was 66 years old with 85% being males and 24 having previous radiation. 17 (27%) fistulae occurred in the cohort with 15/47 (76%) in the non-chimeric group and 2/15 (26%) in the chimeric group (P=0.16). The fistula rate depending on flap type were the following: 6/22 (27%) radial forearm, 9/36 (25%) ALT and 2/4 (50%) pectoralis flaps (P=0.65). Among those with sarcopenia, the rate of fistula formation was 9/25 (36%) compared to 8/36 (22%, p=0.24). No fistula occurred in sarcopenic patients with a chimeric flap. On univariate regression, chimeric flaps showed a protective effect that did not reach statistical significance. On multiple logistic regression, chimeric flaps had a reduced odd of fistula (OR: 0.11, 95% CI of 0.02-0.96), when adjusting for age, sex, previous radiation and sarcopenia. LOS was significantly shorter in the chimeric flap group (18.8 vs 25.9 days, P<0.01). No statistical difference was detected for the association of flap type on feeding tube outcome.
Conclusion: Chimeric flaps may reduce complication rates and hospitalization durations, suggesting a preferred role in laryngectomy reconstructions, especially among sarcopenic patients. These findings support further investigation into the use of chimeric flaps to enhance surgical and functional recovery in appropriate cases.