{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T16:11:02Z","timestamp":1772640662337,"version":"3.50.1"},"reference-count":43,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,8,24]],"date-time":"2020-08-24T00:00:00Z","timestamp":1598227200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To characterize pharyngocutaneous fistula (PCF) rates and functional outcomes following microvascular free tissue transfer (MVFTT) reconstruction of salvage total laryngectomy (STL) with a review of two different flap inset techniques and a review of the literature.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Review of the literature revealed 887 patients who underwent STL MVFTT from 14 references. Ninety\u2010six STL MVFTTs were performed by the authors, with 36 (38%) patients undergoing multilayer fascial underlay (MLFU) closure and 60 (62%) a standard single layer closure (SLC). One (3%) PCF occurred in the MLFU group compared to 12 (20%) in the SLC cohort (<jats:italic>P<\/jats:italic> = .03). Postoperative gastrostomy (G)\u2010tube dependence was lower following MLFU closure compared to SLC (25% vs. 57%, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.01), whereas pharyngoesophageal stricture (PES) (28% vs. 38%), tracheoesophageal puncture (TEP) placement (42% vs. 42%), and TEP usage (87% vs. 88%) did not significantly differ (<jats:italic>P<\/jats:italic>\u2009&gt;\u2009.05). Compared to pooled rates from the literature, patients who underwent a MLFU MVFTT inset technique demonstrated significantly lower PCF incidence (3% vs. 23%, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.01) without significant differences in PES (28% vs 23%, <jats:italic>P<\/jats:italic> = .55), G\u2010tube dependence (25% vs. 23%, <jats:italic>P<\/jats:italic> = .25), or TEP placement (42% vs. 59%, <jats:italic>P<\/jats:italic> = .09).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Despite MVFTT reconstruction after STL, G\u2010tube dependence, PCF formation, and limitations of speaking rehabilitation (TEP) remain a significant issue. Modification of MVFTT inset may provide an opportunity to reduce PCF incidence without affecting other functional outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4 <jats:italic>Laryngoscope<\/jats:italic>, 131:E875\u2013E881, 2021<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.28939","type":"journal-article","created":{"date-parts":[[2020,8,24]],"date-time":"2020-08-24T23:38:33Z","timestamp":1598312313000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Free Flap Inset Techniques in Salvage Laryngopharyngectomy Repair: Impact on Fistula Formation and Function"],"prefix":"10.1002","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1809-7819","authenticated-orcid":false,"given":"Diane W.","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3295-2394","authenticated-orcid":false,"given":"Mark A.","family":"Ellis","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Medical University of South Carolina  Charleston South Carolina U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Horwich","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Medical University of South Carolina  Charleston South Carolina U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9205-385X","authenticated-orcid":false,"given":"Vlad C.","family":"Sandulache","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nelson E.","family":"Liou","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Hernandez","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erich M.","family":"Sturgis","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3766-468X","authenticated-orcid":false,"given":"Evan M.","family":"Graboyes","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Medical University of South Carolina  Charleston South Carolina U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua D.","family":"Hornig","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Medical University of South Carolina  Charleston South Carolina U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Terry A.","family":"Day","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Medical University of South Carolina  Charleston South Carolina U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8588-9264","authenticated-orcid":false,"given":"Andrew T.","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,8,24]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199106133242402"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.129.1.44"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21352"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2016.05.017"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.132.1.67"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21712"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24448"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1995.01890020024006"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.20974"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24619"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLG.0b013e3180332e39"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215114000504"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.20492"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599818765166"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.25367"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2019.03.005"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2019.09.006"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.24947"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0029-1234023"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.25192"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.24837"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.24355"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2013.2761"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0053985"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.23443"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21742"},{"key":"e_1_2_6_28_1","first-page":"448","article-title":"Radial forearm versus anterolateral thigh free flaps for laryngopharyngectomy defects: prospective, randomized trial","volume":"39","author":"Morrissey AT","year":"2010","journal-title":"J Otolaryngol Head Neck Surg"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200107000-00011"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599811432264"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21836"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24717"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599813486257"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24002"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2011.02.007"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2011.02.002"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2008.10.018"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24796"},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2014.08.017"},{"key":"e_1_2_6_40_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599815606438"},{"key":"e_1_2_6_41_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000002915"},{"key":"e_1_2_6_42_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-198601000-00008"},{"key":"e_1_2_6_43_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348949009900701"},{"key":"e_1_2_6_44_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.24529"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.28939","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/lary.28939","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.28939","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,2]],"date-time":"2023-09-02T16:25:48Z","timestamp":1693671948000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.28939"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,24]]},"references-count":43,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021,3]]}},"alternative-id":["10.1002\/lary.28939"],"URL":"https:\/\/doi.org\/10.1002\/lary.28939","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,24]]},"assertion":[{"value":"2020-05-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-06-25","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-08-24","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}