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Modified Continuous Mucosal Connell Suture for the Pharyngeal Closure After Total Laryngectomy: Zipper Suture.

Haksever M, Akduman D, Aslan S, Solmaz F, Ozmen S - Clin Exp Otorhinolaryngol (2015)

Bottom Line: The surgical suture techniques are not studied so much.This technique is a simple modification of continuous mucosal Connell suture.We named it as zipper suture.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, Bursa Sevket Yilmaz Training and Research Hospital, Bursa, Turkey.

ABSTRACT

Objectives: Pharyngocutaneous fistula is a serious complication after total laryngectomy, and there are some risk factors stated in the literature. The surgical suture techniques are not studied so much. The aim of this study is to evaluate the effectiveness of 'modified continuous mucosal Connell suture' on the incidence of pharyngocutaneous fistula after total laryngectomy.

Methods: This is a retrospective case series study based at a tertiary center with 31 patients who underwent total laryngectomy between July 2011 and December 2013. Pharyngocutaneous fistula formation after total laryngectomy was evaluated with the patients who underwent modified continuous mucosal Connell suture for pharyngeal repair.

Results: Pharyngocutaneous fistula was observed in only one patient (3.2%) who had a history of previous radiotherapy, and it was spontaneously healed within 6 days by conservative treatment.

Conclusion: We defined a new suture technique for the pharyngeal repair after total laryngectomy. This technique is a simple modification of continuous mucosal Connell suture. We named it as zipper suture. It is effective in the prevention of pharyngocutaneous fistula for pharyngeal reconstruction after total laryngectomy.

No MeSH data available.


Related in: MedlinePlus

Four different commonly used suture techniques; continuous interlocking (A), Lembert (B), Connell (C), and Gambia (D).
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Figure 1: Four different commonly used suture techniques; continuous interlocking (A), Lembert (B), Connell (C), and Gambia (D).

Mentions: Pharyngocutaneous fistula (PCF) is one of the most troublesome complications in early postoperative period after total laryngectomy. It increases the morbidity and hospital stay significantly. The reported incidence of PCF ranges from 3% to 65% [1]. In the literature, several risk factors such as; preoperative radiotherapy, the type of surgery, concurrent radical neck dissection, the suture material used for pharyngeal reconstruction, the presence of residual tumor, previous neck surgery, preoperative tracheotomy, poor general conditions, the site of tumor origin, intraoperative blood transfusion, low postoperative hemoglobin level, the type of neck drainage, preoperative weight loss, wound infection, postoperative vomiting, and hematoma formation have been proposed to be predisposing to PCF [2]. However, the effect of stitch technique used in the closure of pharyngeal mucosa to the PCF formation has not been studied yet widely. There are a limited number of papers in the literature that compare the manual and mechanical sutures regarding the stitch techniques for pharyngeal repair after total laryngectomy [345]. The surgical steps of a manual closure technique for pharyngeal defect were not clearly defined in any of those studies. As a surgeon can use his/her own technique for pharyngeal closure, the classical and well known stitch techniques do not exceed the number of count of fingers of one hand. Four different stitch techniques; continuous interlocking, Lembert, Connell, and Gambee are demonstrated on the Fig. 1. Any of these techniques, particularly Connell suture can be used for manual pharyngeal closure [6]. Our literature search did not reveal any studies comparing those stitches to each other in terms of PCF formation in total laryngectomy patients.


Modified Continuous Mucosal Connell Suture for the Pharyngeal Closure After Total Laryngectomy: Zipper Suture.

Haksever M, Akduman D, Aslan S, Solmaz F, Ozmen S - Clin Exp Otorhinolaryngol (2015)

Four different commonly used suture techniques; continuous interlocking (A), Lembert (B), Connell (C), and Gambia (D).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553361&req=5

Figure 1: Four different commonly used suture techniques; continuous interlocking (A), Lembert (B), Connell (C), and Gambia (D).
Mentions: Pharyngocutaneous fistula (PCF) is one of the most troublesome complications in early postoperative period after total laryngectomy. It increases the morbidity and hospital stay significantly. The reported incidence of PCF ranges from 3% to 65% [1]. In the literature, several risk factors such as; preoperative radiotherapy, the type of surgery, concurrent radical neck dissection, the suture material used for pharyngeal reconstruction, the presence of residual tumor, previous neck surgery, preoperative tracheotomy, poor general conditions, the site of tumor origin, intraoperative blood transfusion, low postoperative hemoglobin level, the type of neck drainage, preoperative weight loss, wound infection, postoperative vomiting, and hematoma formation have been proposed to be predisposing to PCF [2]. However, the effect of stitch technique used in the closure of pharyngeal mucosa to the PCF formation has not been studied yet widely. There are a limited number of papers in the literature that compare the manual and mechanical sutures regarding the stitch techniques for pharyngeal repair after total laryngectomy [345]. The surgical steps of a manual closure technique for pharyngeal defect were not clearly defined in any of those studies. As a surgeon can use his/her own technique for pharyngeal closure, the classical and well known stitch techniques do not exceed the number of count of fingers of one hand. Four different stitch techniques; continuous interlocking, Lembert, Connell, and Gambee are demonstrated on the Fig. 1. Any of these techniques, particularly Connell suture can be used for manual pharyngeal closure [6]. Our literature search did not reveal any studies comparing those stitches to each other in terms of PCF formation in total laryngectomy patients.

Bottom Line: The surgical suture techniques are not studied so much.This technique is a simple modification of continuous mucosal Connell suture.We named it as zipper suture.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, Bursa Sevket Yilmaz Training and Research Hospital, Bursa, Turkey.

ABSTRACT

Objectives: Pharyngocutaneous fistula is a serious complication after total laryngectomy, and there are some risk factors stated in the literature. The surgical suture techniques are not studied so much. The aim of this study is to evaluate the effectiveness of 'modified continuous mucosal Connell suture' on the incidence of pharyngocutaneous fistula after total laryngectomy.

Methods: This is a retrospective case series study based at a tertiary center with 31 patients who underwent total laryngectomy between July 2011 and December 2013. Pharyngocutaneous fistula formation after total laryngectomy was evaluated with the patients who underwent modified continuous mucosal Connell suture for pharyngeal repair.

Results: Pharyngocutaneous fistula was observed in only one patient (3.2%) who had a history of previous radiotherapy, and it was spontaneously healed within 6 days by conservative treatment.

Conclusion: We defined a new suture technique for the pharyngeal repair after total laryngectomy. This technique is a simple modification of continuous mucosal Connell suture. We named it as zipper suture. It is effective in the prevention of pharyngocutaneous fistula for pharyngeal reconstruction after total laryngectomy.

No MeSH data available.


Related in: MedlinePlus