0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Intraluminal Negative Pressure Wound Therapy for Optimizing Pharyngeal Reconstruction

Scott A. Asher, MD1; Hilliary N. White, MD1; Elisa A. Illing, MD1; William R. Carroll, MD1; J. Scott Magnuson, MD1; Eben L. Rosenthal, MD1
[+] Author Affiliations
1Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, School of Medicine at the University of Alabama at Birmingham, Birmingham
JAMA Otolaryngol Head Neck Surg. 2014;140(2):143-149. doi:10.1001/jamaoto.2013.6143.
Text Size: A A A
Published online

Importance  Pharyngocutaneous fistula formation after pharyngeal reconstruction is one of the most common and challenging problems to manage. Despite many advances in management, the published success rates indicate a role for any adjuvant therapy that could potentially decrease this complication.

Objective  To describe the use of intraluminal negative pressure dressings (NPDs) in pharyngeal reconstruction.

Design, Setting, and Participants  Retrospective case series at a tertiary care academic hospital. Twelve laryngectomy patients underwent pharyngeal reconstruction augmented by placement of an intrapharyngeal NPD in combination with the introduction of vascularized tissue from August 2011 to May 2012. All patients had potential risk factors for compromised wound healing defined as previous radiation therapy, hypothyroidism, diabetes mellitus, compromised nutrition, or established pharyngocutaneous fistula.

Interventions  An NPD was placed in an intraluminal position spanning the length of the pharyngeal defect as part of the reconstructive procedure. The negative pressure sponge was attached to a standard nasogastric tube to which negative pressure was applied. External closure of the pharynx was then achieved with regional or free tissue transfer.

Main Outcomes and Measures  Pharyngeal closure rates, timing until return to oral diet, identification of wound healing risk factors, and adverse events related to use of the device.

Results  Eleven of 12 patients (92%) achieved pharyngeal closure with reconstruction using negative pressure wound therapy. All patients had at least 1 potential risk factor for compromised wound healing, with 11 of 12 (92%) having 2 or more. Seven patients had an established pharyngocutaneous fistula, and 5 patients underwent primary reconstruction after laryngopharyngectomy. In 6 of these 7 patients undergoing fistula repair, pharyngeal closure was achieved, and they resumed an oral diet at 1 week postoperatively. The other had successful leak repair initially, but 1 week later developed a separate area of wound breakdown and a second fistula. All 5 patients in whom an intraluminal NPD was placed at the time of initial vacularized tissue reconstruction were able to resume an oral diet by 3 weeks postoperatively, with 3 of them eating by mouth at 1 week postoperatively. No serious adverse events could be attributed to the use of intraluminal NPDs.

Conclusions and Relevance  Intraluminal negative pressure wound therapy is feasible and safe. Future research should be conducted to determine its potential in optimizing pharyngeal reconstruction in high-risk patients.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Figure 1.
Design of Intraluminal Negative Pressure Wound Therapy System

A, Begin with a standard nasogastric tube (NGT) and standard wound vacuum sponge. The sponge should be trimmed to the appropriate size. B, Scissors or trocar can then be used to create a stab incision in the sponge. C, The NGT is then sized so that no suction fenestrations lie outside of sponge, the NGT is sewn to sponge, and often a Xeroform bolster is attached as well to create optimal seal in the pharynx. The rulers are in centimeters on one side and inches on the other side.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Fistula Closure Strategy

A, Wound prepared with neck flaps reopened, pharyngeal leak identified (arrow), and pectoral flap (PEC) raised and tunneled into the wound. CHIN indicates chin. A red Robinson rubber catheter (RR) is in place from prior tracheoesophageal puncture. ETT indicates an endotracheal tube in a tracheostoma. B, Profile view of a nasogastric tube (NGT) inserted through the nose and led out of the pharyngeal defect, then secured to sponge. C, Sponge positioned into pharyngeal defect. D, PEC flap sewn into position. The NGT can be seen in this view, where it is traveling down from the nose.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Confirmation of Pharyngocutaneous Fistula Closure

Preoperative (A) and postoperative (B) radiographic swallow studies demonstrating leak (arrow) and resolution of leak after repair. C, Endoscopy shows granulation at sight of repair with no sign of fistula.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
Jobs
brightcove.createExperiences();