LARYNGECTOMY FAQ'S

I hear people talking about a 'flap'. Are there different kinds of flaps? What is a stomach pull-up or a jejunum? Is it possible to have a TEP procedure after these surgeries?
(by Glenn E. Peters M.D., Director, Division of Otolaryngology
Head and Neck Surgery, University of Alabama at Birmingham,
Birmingham, Alabama, USA)

Let’s discuss flaps, stomachs, jejunums, and other *chitlins. We need to begin this with a brief review of the laryngectomy. Remember that the larynx sits in the throat or pharynx and when it is removed we have to close the pharynx so you can swallow again. The most common way to reconstruct this area is to simply close it with several layers of sutures, thereby creating a tube through which saliva, solids and liquids can pass. This is called “primary closure”.

Now, the problem comes when we have to deal with larger tumors or tumors that arise on the side or the back of the larynx. This creates a situation where we do not have enough tissue to close the pharynx primarily. In this case we borrow tissue from elsewhere in or on the body to supply this extra tissue needed for closure. This tissue, transferred from another site, is generically called a “FLAP”. So what about these flaps? Historically speaking, we started with skin flaps from the neck and upper chest. We then moved on to flaps from the upper chest, which included a portion of the large muscle on the chest called the pectoralis major. From there we went to using the entire stomach which was turned into a tube and used to recreate not only the throat but also the entire esophagus as well (the gastric “pull-up”). Then we finally got into what are called “free flaps”. These are pieces of tissue which are completely detached from the body -- the “free” part -- and transferred to the neck where they are hooked back up using an operating microscope. The jejunum (a segment of small intestine ) and the radial forearm flap are the most commonly used in this category.

Lastly, the question has arisen as to whether or not a TEP can be used in patients that have had flap reconstruction following their laryngectomies. My answer has always been that this needs to be individualized on a case by case basis. I have put TEPS in just about all of the flaps that I have mentioned above. This includes the gastric pull-up and the jejunum. We are just a little more careful in evaluating patients for this device after the flaps, but it can be done with good results.

*chitlings - (pronounced chit-lins) Southern talk for chitterlings (entrails). From the time of settling of the South, nothing could be wasted and the entrails of the pig were cleaned and used as food prepared in various ways, such as sausage casings, but they were often fried and considered a delicacy.