Wound amylase levels as an early indicator of orocutaneous fistulae

The formation of an orocutaneous fistula following ablative head and neck surgery is a common complication. Early fistula detection could permit prompt management, hopefully preventing further wound breakdowns. Amylase is quantitatively the most prominent enzyme in saliva. This study prospectively evaluated whether the amylase content of wound drainage could predict the formation of an orocutaneous fistula earlier than clinically evident. Patients undergoing procedures that required postoperative wound drainage represented the study population. Baseline serum and salivary amylase determinations were obtained. The drainage was assayed for amylase content twice daily. Wound amylase values were then correlated with the patient's clinical course. Results showed wound amylase had a downward trend in uncomplicated postoperative courses. An upward trend of wound amylase was correlated with early fistulization. No pattern was identified in patients with delayed fistulae.