Factors affecting orocutaneous fistula formation following head and neck reconstructive surgery

This paper explores factors associated with the formation of orocutaneous fistula following head and neck reconstructive surgery, and considers ways this complication may be reduced. We retrospectively analysed the medical notes of 102 patients who had reconstructive surgery at the study centre over a 17-month period. Information included patient comorbidities, previous oncological treatment, duration of hospital stay, complications, incidence of fistulas, and the day on which oral intake started. Patients who had previously had chemoradiotherapy were significantly more likely to develop a fistula than those who had not (p=0.008). Associations between other variables were not significant. Our analysis identifies a considerable number of patients who require head and neck reconstructive surgery as a result of new primary or recurrent tumours within previously irradiated fields. It also demonstrates the impact of previous chemoradiotherapy on many elements of recovery and rehabilitation, including but not limited to fistula formation. Treatment for this group of patients requires careful consideration and planning, as their recovery trajectory may be different from those patients who undergo surgery as a primary intervention. We suggest ways to reduce the incidence of fistulas, which include the avoidance of oral intake before the eighth postoperative day.