Author/Editor		Paleri, Vinidh; Strojan, Primož
Title		Vascularised tissue to reduce fistula following salvage total laryngectomy
Type		članek
Vol. and No.		Letnik 124, št. 8
Publication year		2014
Volume		str. 1848-1853
ISSN		1531-4995 - The Laryngoscope
Language		eng
Abstract		Pharyngocutaneous fistulae (PCF) are known to occur in nearly a third of patients after salvage total laryngectomy (STL). PCF has severe impact on duration of admission and costs, quality of life and can even cause severe complications such as bleeding, infection and death. Many patients need further surgical procedures. The implications for functional outcome and survival are less clear. Several studies have shown that using vascularised tissue from outside the radiation field reduces the risk of PCFs following STL. This review and meta-analysis aims to identify the evidence base to support this hypothesis. Data sources: English language literature from 2004 to 2013 Review Methods: We searched the English language literature for papers published on the subject from 2004 to 2013. Results: Adequate data was available to identify pooled incidence rates from 7 papers. The pooled relative risk derived from 591 patients was 0.63 (95% CI: 0.47 to 0.85), indicating that patients who have flap reconstruction/reinforcement reduced their risk of PCF by a third. Conclusion: This pooled analysis suggests that there is a clear advantage in using vascularised tissue from outside the radiation field in the laryngectomy defect. While some studies show a clear reduction in PCF rates, others suggest that the fistulae that occur are smaller and rarely need repair.
Keywords		laringektomija rak grla fistule rekonstrukcija free flaps pedicled flaps pharyngocutaneous fistula reconstruction