Repairing mucosa defect with heterogeneity (cattle) acellular dermal matrix after pharyngolaryngeal neoplasm resection

Aim: The repair of mucosa defect after resecting pharyngolaryngeal neoplasms plays a direct role on the functional recovery of breathing, pronouncing and swallowing. This study concerns the effect of applying heterogeneity (cattle) acellular dermal matrix on the repair of mucosa defect. Methods: From August 2006 to November 2007, 27 cases of mucosa defect accepted treatment with heterogeneity (cattle) acellular dermal matrix in the Department of Otorhinolaryngology Cervical Surgery, Yantai Yuhuangding Hospital, including 5 cases of cancer of amygdala; 6 cases of cancer of hypopharynx; 16 cases of cancer of larynx, among whom there were 15 cases of cancer of vocal area and 1 cases of cancer of upper vocal area. Pathology of cancer was all epidermoid carcinoma. With the permission of the medical ethics committee and the informed approval of these patients for the experiment and treatment, all the patients were repaired with heterogeneity (cattle) acellular dermal matrix (Yantai Zhenghai Biotechnology Inc., Batch No. SS070603, Specification 2 × 2.5 cm or 4 × 3 cm). The matrix was white and semitransparent tissue, presenting honeycomb appearance, while basal lamina was rough and the other surface was smooth. Patients of cancer of amygdala were treated by stitching behind wound, binding up with iodoform gauze for 7 days. For patients of cancer of larynx, the restoration mucous membrane was carpeted to surface of wound in the small coloboma tissues. If large, the tissue could be firstly mended by strap muscles or muscular fascia, then the restoration mucous membrane was carpeted to surface and stitched up. Afterwards the membrane was stretched for 10-12 days by means of laryngeal extending modules. For patients of cancers of hypopharynx and esophageal cancer, the posterior wall or lateral wall was mended with strap muscles, then the restoration mucous membrane was sutured contrapositionally with the edge of the mucous membrane. After the operation, all the patients were rechecked after 3, 6 and 12 months to observe the wound healing and the functional recovery of breathing, pronouncing and swallowing. Results: For 26 patients of 27 included cases, the repair of mucosa defect was rechecked by electronic laryngoscopy and found healed after operation, while pharyngocutaneous fistula occurred in 1 patients of cancer of hypopharynx after operation and cured by the treatment of dressing change. Postoperative 3-6 months, 4 cases of cancer of amygdala, 6 cases of cancer of larynx and 4 cases of cancer of hypopharynx were checked by e electronic laryngoscopy, the defect was recovered with visible mucous membrane, and the function of breathing and swallowing was satisfying (1 case of the cancer of upper vocal area regained its function after exercise, though the patient coughed at 15 days postoperatively). The patients of cancer of larynx recovered the function of pronouncing, but the resolution was not good; 4 cases of cancer of amygdala were survived for 6 months without recurrence, while 1 reoccurred after 2 months and refused to be treated again, cancer transferring to the neck; 2 cases kept being rechecked for more than one year. Four cases of cancer of hypopharynx kept being rechecked for more than 6 months, and 1 was infected by pharyngocutaneous fistula after operation. After treatment of dressing change and antibiotics, the wound healing was satisfying, but after radiation treatment for 3 months, the case died of massive haemorrhage. Among 16 cases of cancer of larynx, 6 patients kept being rechecked for 6 months, and 1 for one year. Neither rejection nor allergy was found in all the patients. Conclusion: Heterogeneity acellular dermal matrix is a new method to repair mucosa defect after otolaryngology cervical surgery. The operative procedure is easy to perform and obtains good effect, worthwhile to be applied for functional recovery.