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Laryngorhinootologie 2020; 99(04): 229-236
DOI: 10.1055/a-1099-9688
Originalarbeit

Fistelprophylaxe mit muskelsparendem, myofaszialem Pectoralis-major-Lappen bei Salvage-Laryngektomie

Fistula prophylaxis with muscle-sparing, myofascial pectoralis major lobe in salvage laryngectomy
Daniel Dejaco
1   Department for Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Austria
,
Tina Rauchenwald
2   Department for Plastic-, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Austria
,
Teresa Steinbichler
1   Department for Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Austria
,
Dolores Wolfram
2   Department for Plastic-, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Austria
,
Evi Morandi
2   Department for Plastic-, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Austria
,
Elisabeth Appenroth
1   Department for Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Austria
,
Gabriel Djedovic
2   Department for Plastic-, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Austria
,
Gerhard Pierer
2   Department for Plastic-, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Austria
,
Herbert Riechelmann
1   Department for Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Austria
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Zusammenfassung

Hintergrund Bei Rezidiv-Plattenepithelkarzinom des Hypopharynx/Larynx nach Bestrahlung stellt die Salvage-Laryngektomie (Salvage-LE) die beste kurative Therapieoption dar. Vorbestrahlung begünstigt die Entstehung pharyngokutaner Fisteln (pk-Fisteln). Transfer von unbestrahltem Gewebe in das OP-Gebiet reduziert die Fistelrate. Hierfür wird oft ein myokutaner Pectoralis-major-Lappen (PML) verwendet. Wir beschreiben einen muskelsparenden, myofaszialen PML (ms-PML) und dessen funktionelle und ästhetische Resultate.

Methoden Über je eine 8 cm lange subklavikuläre und submammäre horizontale Inzision wird ein am R. pectoralis der A. thoracoacromialis gestielter kraniokaudaler Streifen des M. pectoralis major unter Schonung der Pars clavicularis präpariert und supraklavikulär auf den Pharynx aufgebracht. R0-Resektionsraten, Gesamtüberleben (GS), Komplikationen, stationäre Verweildauern und funktionelle und ästhetische Resultate wurden erhoben.

Ergebnisse Bei 25 Patienten wurde eine Salvage-LE mit ms-PML durchgeführt. Die R0-Resektionsrate betrug 100 %, das mediane GS 1,3 (Beobachtungszeitraum: 2,8) Jahre, die Komplikationsrate 16 % (4 komplette Lappennekrosen, 3 pk-Fisteln) und die mediane stationäre Verweildauer 20 (11–78) Tage. Gute funktionelle Ergebnisse wurden beobachtet: Einschränkungen der oralen Nahrungsaufnahme traten bei 2, Einschränkungen der Stimmrehabilitation bei 3 Patienten auf. Wundheilungsstörungen ohne Lappennekrosen wurden nicht beobachtet. Die ästhetischen Resultate waren ansprechend.

Schlussfolgerung Der ms-PML ist ein wenig invasives und sicheres Verfahren zur Fistelprophylaxe bei Salvage-LE mit günstigem funktionellem und ästhetischem Ergebnis.

Abstract

Background In recurrent hypopharyngeal/laryngeal squamous cell carcinoma after radiation salvage-laryngectomy (salvage-LE) represents the best curative treatment option. Pre-irradiation promotes development of pharyngocutaneous fistulas (pc-fistula). Transfer of unirradiated tissue to the surgical site reduces fistula rate. Frequently, a myocutaneous Pectoralis-major-flap (PMF) is applied. We describe a muscle sparing, myofascial PMF (ms-PMF) and its functional & aesthetic results.

Methods For the ms-PMF, the pectoralis major is exposed via two 8 cm long subclavicular & submammary horizontal incisions. The pectoral branch of the thoracoacromial artery, which represents the blood supply for the ms-PMF, is identified between the clavicular and sternocostal aspect of the muscle. A craniocaudal stripe of the pectoralis major is recovered and supraclaviculary transposed towards the pharynx. The clavicular and sternocostal part of the muscle remain untouched.

The clear-margin resection rate (CMRR), mean overall survival (OS), complications, median length of hospital stay, & functional & aesthetic outcome were assessed.

Results In 25 patients, salvage-LE with ms-PMF was performed. The CMRR was 100 %, median OS 1.3 (follow-up 2.8) years, complications rate 16 % (4 complete lobe necroses, 3 pc-fistulas) and median inpatient stay 20 (11–78) days. Good functional outcome were observed: limitations of oral food intake occurred in 2-, limitations in voice rehabilitation in 3 patients. Wound healing disorders without lobe necrosis were not observed. The aesthetic results were appealing.

Conclusion The ms-PMF is a less invasive & safe procedure for fistula prophylaxis in salvage-LE with favorable functional & aesthetic results.

Schlüsselwörter

Kopf- und Halsplattenepithelzellenkarzinom - Larynxkarzinom - Hypopharynxkarzinom - ästhetische Resultate - funktionelle Resultate - Komplikationen - pharyngokutane Fistel - Dauer des Klinikaufenthalts - Überleben

Key words

head- and neck squamous cell carcinoma - laryngeal carcinoma - hypopharyngeal carcinoma - aesthetic results - functional results - pharyngocutanous fistula


Publication History

Received: 21 October 2019

Accepted: 13 January 2020

Article published online:
20 February 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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