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| |  Novel Approach to Laryngopharyngeal Reconstruction Avoids Adverse Events, Fistula Formation: Presented at IAOO By Louise Gagnon TORONTO -- July 15, 2009 -- The use of a novel approach to laryngopharyngeal reconstruction avoids adverse events such as fistula formation, according to a study presented here on July 9 at the 2nd World Congress of the International Academy of Oral Oncology (IAOO). The anterolateral thigh flap (ALT) is used for pharyngeal reconstruction, but fistula formation can occur in up to 20% of patients who undergo this reconstruction, noted Subramanya Moorthy Halsnad, Department of Oral and Maxillofacial Surgery, University Hospital Birmingham, Birmingham, United Kingdom. Patients typically experience postoperative morbidity with this procedure, having challenges with swallowing after they have undergone pharyngeal reconstruction, explained Dr. Halsnad. "Reconstruction is very complicated," he said in an interview. "There is morbidity in the sense that patients end up having difficulty in swallowing. Invariably, they end up having a feeding tube going into their stomach." The researchers have attempted to decrease that complication by using the Montgomery salivary bypass tube for an extended period of time (~6 weeks). In addition, they have performed a modification of ALT reconstruction by harvesting skin from the large cuff of fascia overlying the quadriceps to gain a third layer of closure and support at the proximal and distal ends of the pharyngeal anastomosis. They have performed 4 cases to date, and no fistula formation has occurred in any of these cases. Patients have not complained of additional discomfort compared with the standard ALT procedure, said Dr. Halsnad. The modified approach is no more technically difficult from the standard approach of using ALT in pharyngeal reconstruction, he added. "The main modification in this procedure is that we harvest a wider fascia underneath the [ALT] flap, so when you perform closure, you get a third layer of closure," said Dr. Halsnad. "The skin, muscle tissue, and fascia are all closed up." Dr. Halsnad said he and his colleagues will continue to perform the modified surgery in patients and will report results of a larger series of cases in the future, but researchers will not study standard pharyngeal reconstruction to modified reconstruction in a comparative way. [Presentation title: The Anterolateral Thigh Flap Fascial Layer in Pharyngeal Reconstruction: Three Layers for the Price of Two. Abstract P2.65]
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