Role of cervical fascia flap in reducing the incidence of pharyngocutaneous fistula after total laryngectomy

Abstract

The aim of the current randomized clinical trial is to evaluate the efficacy of the superiorly based cervical fascia flap in reducing the incidence of the PCF after total laryngectomy. Additionally, the functional outcomes in terms of postoperative swallowing functions were evaluated. This parallel randomized clinical trial included 50 patients undergoing total laryngectomy, randomly assigned to either a cervical fascia flap group (n = 25) or a control group (n = 25). In the cervical fascia group, a superiorly based flap from the investing layer of the deep cervical fascia was used to reinforce the pharyngeal closure. The primary outcome was the incidence of PCF. Secondary outcomes included postoperative swallowing function assessed three months postoperatively using the Eating Assessment Tool (EAT-10) and videofluoroscopic swallowing study. PCF occurred in 2 patients (8%) in the cervical fascia group compared with 8 patients (32%) in the control group, demonstrating a statistically significant reduction (p = 0.034). Swallowing outcomes were significantly better in the cervical fascia group, with lower median EAT-10 scores (p = 0.001) and more favorable videofluoroscopic findings (p = 0.039). The use of cervical fascia for pharyngeal repair after total laryngectomy is effective in reducing the incidence of pharyngocutaneous fistula. Its main advantages include technical simplicity, cost-effectiveness, and availability within the same surgical field, without the need for additional incisions, prolonged operative time, or donor-site morbidity. Furthermore, this technique is associated with favorable postoperative swallowing outcomes.