Clin Exp Otorhinolaryngol.  2015 Sep;8(3):281-288. 10.3342/ceo.2015.8.3.281.

Modified Continuous Mucosal Connell Suture for the Pharyngeal Closure After Total Laryngectomy: Zipper Suture

• Haksever M
• Akduman D
• Aslan S
• Solmaz F
• Ozmen S

• KMID: 2117525
• DOI: http://doi.org/10.3342/ceo.2015.8.3.281

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.

Keyword

Fistula; Laryngectomy; Zipper Suture; Suture Techniques, Risk Factors, Drainage

MeSH Terms

Fistula
Humans
Incidence
Laryngectomy*
Radiotherapy
Retrospective Studies
Risk Factors
Suture Techniques
Sutures*

Figure

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  Fig. 1 Four different commonly used suture techniques; continuous interlocking (A), Lembert (B), Connell (C), and Gambia (D).

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  Fig. 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.

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  Fig. 3 Semi closed pharyngeal defect. Note that oblige position of porteque and needle. Assistant keeps the vicryl in tension to provide inversion of mucosa and not to permit relaxation. (A) Zipper suture on synthetic material. (B) Note that the spontaneous inversion of the edges.

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  Fig. 4 Close-up view of the zipper suture technique. Note the stitch pattern of 'far outside in and near inside out'.

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  Fig. 5 Closed pharyngeal defect: schematic diagram of pharyngeal repair with zipper suture (A, B), pharyngeal repair of the case focused at suture line (C).

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  Fig. 6 (A-E) Schematic diagram of T type pharyngeal repair with zipper suture.

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