Pharyngocutaneous fistulas: management with one-stage flap reconstruction

After total laryngectomy, postoperative pharyngocutaneous fistula still constitutes a most troublesome and challenging problem. We present 9 cases of postoperative fistulas managed by one-stage flap reconstruction. Possible contributing factors related to earlier management or medical status are identified. When the posterior pharyngeal wall was intact in a large pharyngocutaneous fistula, 4 pectoralis major and 2 latissimus dorsi double island musculocutaneous flaps were used. Autogenous jejunal free grafts were used in 3 patients when circumferential reconstruction was required. The cervical esophagus was successfully reconstructed, facilitating swallowing function, in a one-stage procedure in each patient.