Swallowing function and tracheotomy dependence after combined-modality treatment including free tissue transfer for advanced-stage XXXX .

@entity5 @entity1 @entity189
OBJECTIVES/HYPOTHESIS: There are many treatments available for advanced @entity5 . Organ-sparing protocols reserve surgery for salvage and are thought to provide adequate rehabilitation. Surgical resection with free tissue transfer may also provide adequate functional rehabilitation. The objective was to describe swallowing status and time to decannulation in a series of @entity1 treated with combined-modality therapy that included free flap reconstruction. STUDY DESIGN: Retrospective chart review. METHODS: @entity1 data were obtained from medical records of 20 @entity1 with stage III or IV @entity189 , who were consecutively treated with surgical @entity5 extirpation, free flap reconstruction, and postoperative irradiation at a tertiary academic center from 1985 to 2002. The following variables were identified: @entity1 and @entity5 characteristics, free flap type, irradiation data, and airway and swallowing status before and after treatment. RESULTS: One @entity1 underwent total laryngopharyngectomy, and the remaining 19 @entity1 underwent tracheotomy at the time of definitive surgery. Free flap reconstructions included 1 ulnar and 15 radial forearm fasciocutaneous flaps and 4 fibula osteocutaneous flaps. Postoperatively, all 19 tracheotomized @entity1 had successful decannulation. Average time to decannulation was 15 days (range, 3-42 d). After surgery and before irradiation, 13 @entity1 initiated oral intake, on average, at 19.5 days (range, 7-28 d); 6 @entity1 required no additional supplementation. By 4 months after surgery, having completed radiation therapy, 10 @entity1 were consuming all nutrition orally; the other 10 @entity1 still required tube-feed supplementation, although 6 of these @entity1 were also eating by mouth. CONCLUSION: Combined-modality treatment that includes free flap reconstruction for advanced-stage @entity5 may provide reasonable functional rehabilitation with respect to postoperative airway and swallowing.
