In reference to Vascularized tissue to reduce fistula following salvage total laryngectomy: a systematic review.

We were pleased to read Paleri and coauthors’ article “Vascularized Tissue to Reduce Fistula Following Salvage Total Laryngectomy: A Systematic Review” published in The Laryngoscope’s August 2014 issue. The review found a decrease in the rate of pharyngocutaneous fistulas by one third in salvage laryngectomy patients treated with a vascularized flap. Our group has previously published on this matter in this same journal in February 2012. In our study, “Temporoparietal Fascia Free Flap for Pharyngeal Coverage After Salvage Total Laryngectomy,” we found an 8% risk of pharyngocutaneous fistula when salvage laryngectomy patients had a temporoparietal fascia flap used as a reinforcement closure layer. We were surprised to see that our article was not cited in Paleri and coauthors’ systematic review. Our title itself includes two of their key word searches: free flap and salvage total laryngectomy. This brings up two important issues that are worth mentioning: 1) The temporalis fascia flap as an onlay reinforcement flap is a viable option that is worth considering in salvage total laryngectomy cases. The flap is relatively easy to harvest, has low donor site morbidity, and has good cosmetic outcomes. 2) Systematic reviews should follow certain guidelines that are available (e.g, PRISMA, http://www.prisma-statement.org/ or Cochrane Review, http://www.cochrane.org/cochrane-reviews). Paleri and coauthors mentioned their search period dates and key word search terms; however, they failed to document the search process in any detail. Using MEDLINE alone, as a search engine, is considered inadequate by many experts including the Cochrane Review. In addition, a through keyword search would use a wide variety of synonyms and related terms. A good systematic review after all is inclusive of all relevant studies and more importantly is reproducible.