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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

(A) Pharyngeal defect after total laryngectomy. (B) Schematic diagram of the modified continuous Connell suture (zipper suture). Note that the distance (shown by χ in panel B) is preserved between every following stitch, and none of following stitches are on the same line vertically and horizontally. TS, tension suture; NG, nasogastric tube.
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Figure 2: (A) Pharyngeal defect after total laryngectomy. (B) Schematic diagram of the modified continuous Connell suture (zipper suture). Note that the distance (shown by χ in panel B) is preserved between every following stitch, and none of following stitches are on the same line vertically and horizontally. TS, tension suture; NG, nasogastric tube.

Mentions: A standard total laryngectomy with/without neck dissection was performed to all patients. After total laryngectomy, a nasogastric tube was inserted for postoperative feeding before starting the pharyngeal closure. Then, two independent sutures were applied to the corners of pharyngeal defect in the horizontal plane. The ends of suture were tensioned to the right/left sides of pharynx with a forceps and the closure shape of pharynx (horizontal or T type) was determined with this manner (Fig. 2A). Starting from one corner of pharyngeal defect, the continuous modified Connell suture (zipper suture) was applied to all wound edges.


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)

(A) Pharyngeal defect after total laryngectomy. (B) Schematic diagram of the modified continuous Connell suture (zipper suture). Note that the distance (shown by χ in panel B) is preserved between every following stitch, and none of following stitches are on the same line vertically and horizontally. TS, tension suture; NG, nasogastric tube.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: (A) Pharyngeal defect after total laryngectomy. (B) Schematic diagram of the modified continuous Connell suture (zipper suture). Note that the distance (shown by χ in panel B) is preserved between every following stitch, and none of following stitches are on the same line vertically and horizontally. TS, tension suture; NG, nasogastric tube.
Mentions: A standard total laryngectomy with/without neck dissection was performed to all patients. After total laryngectomy, a nasogastric tube was inserted for postoperative feeding before starting the pharyngeal closure. Then, two independent sutures were applied to the corners of pharyngeal defect in the horizontal plane. The ends of suture were tensioned to the right/left sides of pharynx with a forceps and the closure shape of pharynx (horizontal or T type) was determined with this manner (Fig. 2A). Starting from one corner of pharyngeal defect, the continuous modified Connell suture (zipper suture) was applied to all wound edges.

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