Local treatment of a pharyngocutaneous fistula secondary to osteoradionecrosis

Radionecrosis is a late, and difficult to treat,complication of radiotherapy performed on head and neck tumours, and it is difficult to treat. This process causes significant damage, not only in the skin, but also in muscular, nervous, vascular, and bone structures. This, in turn, leads to airway and digestive tract involvement, as well as a functional loss and a cosmetic defect that usually requires reconstructive surgery. Therefore, this process is associated with a significant loss in the quality of life of patients and involves a long hospital stay for treatment, as well as the necessary support measures. This article describes the local treatment of pharyngocutaneous fistula secondary to radiation therapy of squamous cell carcinoma of the right oropharynx. The lesion appeared two months after completing this treatment and required surgical reconstruction with a myocutaneous flap to repair the tissue defect. In this context, an alginate wound dressing with silver was used, combined with a medium grip polyurethane foam with a silicone border. Within one month, there was autolytic debridement of all the necrotic tissue and the appearance of granulation tissue. At the same time, the infection was controlled, and a better management of the exudate was obtained, which provided a suitable surgical bed for the reconstruction.