Application of acellular dermalmatrix in laryngopharyngectomy: 25-case follow-up / 中国组织工程研究

ABSTRACT

BACKGROUND: Acellular dermalmatrix (ADM), as a new material, is generally applied to tissue repair after head and neck tumorectomy. However, hypopharyngeal carcinoma surgery always involves in repair and functional reconstruction of defected tissue; therefore, the application effect of ADM needs to be further studied for repairing laryngopharynx defect. OBJECTIVE: To evaluate the clinical effect of ADM in repairing laryngopharynx defect following tumorectomy. DESIGN, TIME AND SETTING: A retrospective case analysis was performed at the Department of Otolaryngology-Head and Neck Surgery, Institute of Battle Surgery, Daping Hospital, the Third Military Medical University of Chinese PLA from May 2005 to June 2006.PATICIPANTS A total of 25 male cases aged 45-68 years including 22 patients with tumor in the lateral wall of the unilateral piriform fossa and 3 patients with in the posterior wall of laryngopharynxat were finally diagnosed as squamous cell carcinoma. METHODS: According to clinical stages, patients underwent partial or complete laryngopharyngectomy. ADM was used to repair oropharynx mucosa following the laryngopharyngectomy. However, ADM alone was used to repair piece-shaped oropharynx mucosa, limiting by being unable to complete reconstruction of spatial structure. Therefore, myocutaneous flap or other materials combined with ADM was beneficial for reconstruction of laryngopharyngeal cavity following complete laryngopharyngectomy. MAIN OUTCOME MEASURES: The effect of ADM on functional reconstruction of swallowing, breathing, and pronouncing. RESULTS: A total of 25 patients were included in the final analysis. No patients suffered with the pharyngeal fistula. Only one case encountered the subcutaneous infection at day 20 after surgery, but recovering after regular change of dressing and treatment of antibiotics. About 15 patients who accepted the surgery of partial laryngopharyngectomy suffered with bucking, but after 30-60 days, the symptom relieved, even disappeared, in spite of 3 cases still bucking when they swallowed liquid diet. Breathing function was recovered, and tracheal cannula was removed 6-12 months after surgery. Ten of them who accepted total laryngopharyngectomy had resumption of normal oral diet after 20 days. The follow-up periods after the surgery lasted 12-30 months. The allograft became normal mucosa finally, without rejection or scar formation. The follow-up of 10 patients lasted more than 24 months, one case had relapse of tumor, still alive after the second surgery. CONCLUSION: ADM with perfect histocompatibility and easy operability, can be applied to repair deletion of laryngeal or pharyngeal tissue and recover functions of pronouncing, breathing, and swallowing after tumorectomy. The combined use of ADM and musculo-cutaneous flap was effective and satisfactory.