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Pharyngocutaneous fistula.

Antti A Mäkitie1, Jonathan Irish, Patrick J Gullane

  • 1Toronto General Hospital, Eaton North 7-242, 200 Elizabeth Street, Toronto, ON, M5G 2C4 Canada. patrick.gullane@uhn.on.ca

Current Opinion in Otolaryngology & Head and Neck Surgery
|September 30, 2003
PubMed
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Pharyngocutaneous fistula is a common complication after head and neck cancer surgery. Recognizing risk factors and optimizing perioperative care can prevent or minimize fistulae, improving patient outcomes.

Area of Science:

  • Otolaryngology
  • Surgical Oncology
  • Plastic Surgery

Background:

  • Pharyngocutaneous fistula is a frequent and serious complication following head and neck oncologic surgery, particularly after hypopharyngeal and laryngeal ablative procedures.
  • The etiology and management strategies for pharyngocutaneous fistulae remain subjects of ongoing debate and controversy within the medical community.

Purpose of the Study:

  • To highlight the significance of identifying and addressing risk factors for impaired wound healing during preoperative planning for head and neck cancer patients.
  • To emphasize the critical role of perioperative technical precision and diligent postoperative care in preventing pharyngocutaneous fistulae and mitigating associated complications.
  • To discuss the increased risk of complications, including fistulae, in patients undergoing surgical salvage after organ preservation therapies, especially when mucosal integrity is compromised.

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Main Methods:

  • Review of contributing risk factors for impaired wound healing in head and neck surgery.
  • Analysis of perioperative technical considerations and preventive postoperative care strategies.
  • Evaluation of outcomes for patients undergoing surgical repair, including the use of myocutaneous flaps and free tissue transfers.

Main Results:

  • Pharyngocutaneous fistula is the most common complication after major hypopharyngeal and laryngeal ablative surgery.
  • Preoperative recognition of risk factors and meticulous perioperative management are crucial for fistula prevention.
  • Surgical salvage cases, particularly those involving mucosal closure, exhibit higher complication rates.

Conclusions:

  • Effective prevention and management of pharyngocutaneous fistulae require a comprehensive approach, integrating preoperative risk assessment, surgical expertise, and postoperative care.
  • Patients requiring complex reconstructive procedures, such as those treated with myocutaneous flaps or free tissue transfers, benefit from specialized care at centers of excellence with robust multidisciplinary head and neck programs.