Prophylactic antibiotics and post laryngectomy pharyngocutaneous fistulae

Pharyngo-cutaneous fistula following laryngectomy is a serious complication. The incidence worldwide varies from 7.6 to 50 per cent. The value of prophylactic antibiotics in preventing fistulae is well recognized but the type of antibiotics and the length of administration of the antibiotics is variable depending on the individual surgeon. Below we present the Plymouth Head and Neck Unit experience where, in the last five years, 33 patients underwent laryngectomy (30 total, three vertical hemi-laryngectomies). The prophylactic antibiotics used in all patients was parenteral cefotaxime 1G or cefuroxime 750 mg, given at eight hours pre-operatively, with the premedication and at eight, 16 and 24 hours post-operatively. Only two patients developed pharyngo-cutaneous fistulae, both after total laryngectomy (six per cent of total). Three patients developed skin cellulitis and five patients developed chest infection which required further treatment with antibiotics.