Purpose of Review
Although associated with significant morbidity including fistula, stricture, poor voice rehabilitation, and even death, salvage laryngectomy and laryngopharyngectomy will remain as important surgical procedures as long as transoral surgery and chemoradiation therapy continue to be employed primarily in the treatment of laryngeal malignancy.
Recent Findings
Multi-institutional retrospective analyses indicate that onlay pectoralis myofascial flaps may reduce the incidence of post-operative fistula to 10–15 % compared to 30 % associated with primary closure alone. Regional and distant fasciocutaneous flaps have limited morbidity and their use may minimize the rates of stricture. Employment of salivary bypass tubes appears to reduce the incidence of fistula to less than 10 %. Voice rehabilitation outcomes with tracheoesophageal puncture are equivalent between fasciocutaneous flaps and primary closure, and better than the voice quality attained with enteric flaps or pectoralis flaps.
Summary
Pectoralis onlay flaps are a viable option in select patients undergoing primary closure who are aware of the associated morbidity and voice outcomes. Free tissue transfer, in particular the anterolateral thigh flap, used in conjunction with salivary bypass tubes offers an ideal balance of donor site morbidity, post-operative fistula, and voice rehabilitation, and should be considered for appropriate patients.