Platelet-rich fibrin: an autologous biomaterial for healing assistance of pharyngeal repair in total laryngectomy
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LARYNGOLOGY
Platelet‑rich fibrin: an autologous biomaterial for healing assistance of pharyngeal repair in total laryngectomy Ahmed Mostafa Eid1 · Hisham Atef Ebada1 · Ahmed Musaad Abd El‑Fattah1 · Ali Tawfik1 Received: 18 August 2020 / Accepted: 24 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objectives The aim of this study was to evaluate the potential role of platelet-rich fibrin (PRF) application on the pharyngeal repair on decreasing the incidence of pharyngocutaneous fistula (PCF) after total laryngectomy. Methods This randomized controlled clinical trial was conducted on 67 patients with advanced laryngeal carcinoma who underwent total laryngectomy, over 2 years in the Otorhinolaryngology Department, Mansoura University Hospitals, Egypt. Patients were randomly assigned into two groups: PRF group (n = 35) and control group (n = 32). Risk factors for development of PCF as well as the incidence of PCF were studied in both groups. Results There was no statistically significant difference between groups regarding demographic data, medical comorbidities, basal hemoglobin and albumin levels, data related to the tumor (location, grade and TNM staging) and surgical details (preoperative tracheotomy and neck dissection). However, regarding the incidence of PCF, there was a statistically significant difference between groups as shown in Table 2. PCF was detected in 2/35 patients (5.7%) in the PRF group and in 10/32 patients (31.3%) in the control group (p = 0.004). Conclusion PRF application on the pharyngeal repair after total laryngectomy enhances the healing process and consequently decreases the incidence of PCF. Keywords Platelet-rich fibrin · Total laryngectomy · Pharyngocutaneous fistula
Introduction Pharyngocutaneous fistula (PCF) is the most common complication after total laryngectomy and the most difficult to manage [1]. PCF is initiated by salivary leakage from the pharyngeal closure site, followed by the accumulation of this leakage material between the pharynx and skin [2]. The incidence of PCF after total laryngectomy varies from 3 to 65% [3–8]. Multiple risk factors for development of PCF have been extensively investigated in the literature. These factors are classified into patient-related factors (gender, age, smoking, alcohol consumption, diabetes, heart disease, gastro-esophageal reflux disease, decreased preoperative hemoglobin, albumin and calcium levels, previous surgical treatment, previous radiotherapy or chemoradiotherapy) [7, 9–11], * Hisham Atef Ebada [email protected] 1
Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura 35511, Egypt
tumor-related factors (stage, lymph nodes and pharynx involvement) [10–12] and treatment-related factors (marginal status, type and technique of closure, experience of the surgeon, preoperative tracheotomy and wound infection) [7, 13]. PCF is a major cause of increased morbidity after total laryngectomy; it delays starting of adjuvant therapy, prolongs hospitalization,
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