Authors: Alam DS, Vivek PP, Kmiecik J
Title: Comparison of voice outcomes after radial forearm free flap reconstruction versus primary closure after laryngectomy
Source: Otolaryngology - Head and Neck Surgery 2008 139(2): 240-244
Year: 2008
Research Design: Non Randomised Controlled Trial
Rating Score: 04/10
This rating is confirmed
Eligibility specified - Y
Random allocation - N
Concealed allocation - N
Baseline comparability - N
Blind subjects - N
Blind therapists - N
Blind assessors - Y
Adequate follow-up - Y
Intention-to-treat analysis - N
Between-group comparisons - Y
Point estimates and variability - Y

Objective: Laryngectomy with primary closure and tracheoesophageal prosthesis (TEP) voice rehabilitation has been the mainstay of the management of patients with advanced laryngeal malignancy. When adequate mucosal tissue is not available, pharyngeal reconstruction with free flaps can be utilized. The speech outcomes of these patients have been traditionally considered inferior based on the findings of a limited number of studies. We report the results of a review of our experience with radial forearm free flap (RFFF) reconstruction of extensive laryngopharyngectomy defects vs our institutional outcomes seen with primary closure. Study Design: Retrospective review. Subjects and Methods: All patients treated with laryngectomy procedures with either primary closure (28 patients) or RFFF (20 patients) reconstructions at the Cleveland Clinic from 2002 through 2007 were included. Blinded evaluation with statistical analysis of standard speech outcomes measures (maximal sustained phonation, fluent count) as well as qualitative variables are reported. Results: Based on our data collection, the two groups are statistically indistinguishable. Conclusions: These findings support the utility and effectiveness of the RFFF in pharyngeal reconstruction in achieving good voice outcomes.

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