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CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(05): 617-632
DOI: 10.1055/s-0042-1756347
Pediatric/Craniomilofacial/Head & Neck: Review Article

Definitive Closure of the Tracheoesophageal Puncture Site after Oncologic Laryngectomy: A Systematic Review and Meta-Analysis

Joseph M. Escandón    §
1   Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, New York, New York
,
Arbab Mohammad   §
2   Department of Surgery, Aarupadai Veedu Medical College and Hospital, Puducherry, Tamil Nadu, India
,
Saumya Mathews
3   Department of Plastic and Microvascular Services, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Valeria P. Bustos
4   Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Eric Santamaría
5   Department of Plastic and Reconstructive Surgery, National Cancer Institute, Hospital General Dr. Manuel Gea Gonzalez, Mexico City, Mexico
,
Pedro Ciudad
6   Reconstructive and Burn Surgery Department, Arzobispo Loayza National Hospital, Lima, Peru
7   Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan
,
Hung-Chi Chen
7   Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan
,
Howard N. Langstein
1   Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, New York, New York
,
Oscar J. Manrique 
1   Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, New York, New York
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Funding None.
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Abstract

Tracheoesophageal puncture (TEP) and voice prosthesis insertion following laryngectomy may fail to form an adequate seal. When spontaneous closure of the fistula tract does not occur after conservative measures, surgical closure is required. The purpose of this study was to summarize the available evidence on surgical methods for TEP site closure.

A comprehensive search across PubMed, Web of Science, SCOPUS, and Cochrane was performed to identify studies describing surgical techniques, outcomes, and complications for TEP closure. We evaluated the rate of unsuccessful TEP closure after surgical management. A meta-analysis with a random-effect method was performed.

Thirty-four studies reporting on 144 patients satisfied inclusion criteria. The overall incidence of an unsuccessful TEP surgical closure was 6% (95% confidence interval [CI] 1–13%). Subgroup analysis showed an unsuccessful TEP closure rate for silicone button of 8% (95% CI < 1–43%), 7% (95% CI < 1–34%) for dermal graft interposition, < 1% (95% CI < 1–37%) for radial forearm free flap, < 1% (95% CI < 1–52%) for ligation of the fistula, 17% (95% CI < 1–64%) for interposition of a deltopectoral flap, 9% (95% CI < 1–28%) for primary closure, and 2% (95% CI < 1–20%) for interposition of a sternocleidomastoid muscle flap.

Critical assessment of the reconstructive modality should take into consideration previous history of surgery or radiotherapy. Nonirradiated fields and small defects may benefit from fistula excision and tracheal and esophageal multilayer closure. In cases of previous radiotherapy, local flaps or free tissue transfer yield high successful TEP closure rates. Depending on the defect size, sternocleidomastoid muscle flap or fasciocutaneous free flaps are optimal alternatives.

Keywords

punctures - prosthesis failure - tracheoesophageal fistula - wound closure techniques - TEP closure - laryngectomy - meta-analysis

Disclosures

The authors have no financial interest to declare in relation to the content of this article. All authors have completed the ICMJE uniform disclosure form.


Authors' Contributions

Idea and conceptualization: S.M. and J.M.E.; Research and investigation: A.M. and J.M.E.; Data curation: A.M. and J.M.E.; Analysis: V.P.B., O.J.M., J.M.E.; Funding acquisition: J.M.E.; Methodology: J.M.E.; Project administration: A.M., V.P.B., J.M.E.; Software and simulation: V.P.B. and J.M.E.; Supervision: S.M., O.J.M., H.C.C., E.S., P.C.; Verification: S.M. and O.J.M.; Original draft preparation: all authors; Revision and editing: all authors.


Note

This article was previously presented at the 90th Annual meeting of the American Society of Plastic Surgery (ASPS) in Atlanta, Georgia, October 29th through November 1st, 2021.


Ethical Approval

The present manuscript did not require IRB approval.


§ Both authors contributed equally to this manuscript and are co-first authors.


Supplementary Material



Publikationsverlauf

Eingereicht: 25. August 2021

Angenommen: 08. Juni 2022

Artikel online veröffentlicht:
23. September 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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