ABSTRACT
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Subject(s)
Humans , Male , Female , Oropharyngeal Neoplasms/surgery , Hypopharynx/surgeryABSTRACT
Introducción y objetivos: La reconstrucción de orofaringe e hipofaringe demanda importante recursos técnicos y humanos. El objetivo es analizar nuestro programa de reconstrucción durante los últimos 13 años. Métodos: Se realizó un estudio retrospectivo de 43 procedimientos reconstructivos de orofaringe e hipofaringe realizados entre 19932008. Resultado: El 67,4 % (29/43) fueron microvasculares (fasciocutáneo radial 17, recto anterior del abdomen 10, escapular 1, yeyuno 1) y el 42,6% (14/43) miocutaneos (pectoral mayor 13, dorsal ancho 1). El 83% (37/43) eran tumores de orofaringe y el 17% (6/43) de hipofaringe, siendo estadio IV el 70% (30/43), 26% (11/43) estadio III y 4% (2/43) estadio II. La estancia media fue de 54 días. El 74,4% (32/43) presentó algún tipo de complicación postoperatoria, siendo la más frecuente la fístula salivar, 62,5% (20/32). El fracaso por necrosis de los colgajos microvasculares fue del 20% (6/29). Se realizó un microvascular cada 5,5 meses, y un miocutáneos cada 11,1 meses. La radioterapia previa y la cirugía de rescate no influyeron de forma significativa en la incidencia de complicaciones. Conclusiones: La reconstrucción es un reto apasionante y agradecido cuando todo va bien, pero cuando fracasa, es frustrante para el médico, pero mucho más lo es para el paciente. Por ello, la colaboración entre equipos implicados en la reconstrucción de cabeza y cuello es importante sobre todo en centros en los que el volumen de pacientes no permite adquirir, de forma rápida, la destreza y experiencia que este tipo de cirugía requiere (AU)
Introduction and objectives: Oropharyngeal and hypopharyngeal reconstructions require significant human and technical resources. This study analysed our reconstruction program over the last 13 years. Material and Methods: Retrospective study in a tertiary reference centre. Results: Forty-three reconstruction procedures, of which 67.4 % (29/43) were microvascular (radial forearm 17, rectus abdominis 10, scapular 1, jejunum 1) and 42.6% (14/43) myocutaneous (pectoralis major 13, latissimus dorsi 1). Of these reconstructions, 83% (37/43) were for oropharyngeal defects and 17% (6/43) for hypopharyngeal defects, with 70% Stage IV (30/43), 26% Stage III (11/43) and 4% (2/43) Stage II. Mean Hospital stay was 54 days. Complications were present in 74.4% (32/43), salivary fistula being the most frequent (62.5%; 20/32). Ischemic necrosis was present in 20% (6/29) of the microvascular flaps. One microvascular flap was performed every 5.5 months, and one myocutaneous every 11.1 months. Previous radiotherapy and salvage surgery did not significantly increase the rate of complications. Conclusions: Reconstruction of pharyngeal defects is a challenging and demanding task, one that is great when everything runs perfectly and disastrous when failure takes place, mainly for the patient. Disciplines related with head and neck reconstruction should create multidisciplinary teams to increase experience, particularly in centres where the number of patients available makes it difficult to get the expertise and confidence this surgery demands for accomplishing the objectives of patient satisfaction and functional restoration (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Adult , Hypopharyngeal Neoplasms/surgery , Oropharyngeal Neoplasms/surgery , Surgical Flaps , Otorhinolaryngologic Surgical Procedures/methods , Plastic Surgery Procedures , Retrospective StudiesABSTRACT
INTRODUCTION AND OBJECTIVES: Oropharyngeal and hypopharyngeal reconstructions require significant human and technical resources. This study analysed our reconstruction program over the last 13 years. MATERIAL AND METHODS: Retrospective study in a tertiary reference centre. RESULTS: Forty-three reconstruction procedures, of which 67.4 % (29/43) were microvascular (radial forearm 17, rectus abdominis 10, scapular 1, jejunum 1) and 42.6% (14/43) myocutaneous (pectoralis major 13, latissimus dorsi 1). Of these reconstructions, 83% (37/43) were for oropharyngeal defects and 17% (6/43) for hypopharyngeal defects, with 70% Stage iv (30/43), 26% Stage iii (11/43) and 4% (2/43) Stage ii. Mean Hospital stay was 54 days. Complications were present in 74.4% (32/43), salivary fistula being the most frequent (62.5%; 20/32). Ischemic necrosis was present in 20% (6/29) of the microvascular flaps. One microvascular flap was performed every 5.5 months, and one myocutaneous every 11.1 months. Previous radiotherapy and salvage surgery did not significantly increase the rate of complications. CONCLUSIONS: Reconstruction of pharyngeal defects is a challenging and demanding task, one that is great when everything runs perfectly and disastrous when failure takes place, mainly for the patient. Disciplines related with head and neck reconstruction should create multidisciplinary teams to increase experience, particularly in centres where the number of patients available makes it difficult to get the expertise and confidence this surgery demands for accomplishing the objectives of patient satisfaction and functional restoration.
