Pharyngocutaneous fistula is the most common complication after total laryngectomy. Pharyngocutaneous fistula pcf is a common and severe complication after salvage total laryngectomy. Pharyngocutaneous fistula as a complication of total. Closure with musculocutaneous or muscle flaps riley rees, md, asher cary, md, r.
Pdf pharyngocutaneous fistula following total laryngectomy. Prevention of pharyngocutaneous fistula in salvage total. To establish the incidence of this complication and to analyze the predisposing factors. The occurrence of pharyngocutaneous fistula after oncologic head and neck surgery is a serious complication. The cause and management guidelines are still controversial. Surgical management of pharyngocutaneous fistula after. It is the most common complication after major hypopharyngeal and laryngeal ablative surgery. A prospective study of pharyngocutaneous fistulas following.
The rate of pharyngocutaneous fistula is about65% when chemoradiation therapy is performed before surgery 1234. Can tissue adhesives and plateletrich plasma prevent pharyngocutaneous fistula formation. Pharyngocutaneous fistula pcf is the most common complication after total laryngectomy. Mar 30, 2006 pharyngocutaneous fistula is the most common complication after total laryngectomy.
Sternocleidomastoid muscle flap is also used for fistula closure which has advantages of workable mass, good coverage and single stage reconstruction. Retrospective cohort analysis was performed using patients undergoing total laryngectomy in the acsnsqip database for 2006. The increased use of radiation in the primary management of laryngeal carcinoma has resulted in an increase in pharyngocutaneous fistula pcf formation after salvage laryngectomy. Perioperative factors predisposing to pharyngocutaneous. The indication for surgery primary versus salvage treatment, and.
When the posterior pharyngeal wall was intact in a large pharyngocutaneous fistula, 4 pectoralis major and 2 latissimus dotsi double island musculocutaneous flaps were used. Pharyngocutaneous fistula pcf is the most common complication after total laryngectomy, with an incidence of 3 15% and its prevalence is further increasing with radioand chemoradiotherapy. May 26, 2011 between 2001 and 2010, 20 patients were treated for pharyngocutaneous fistulae after primary closure of a salvage laryngectomy. The appearance of pharyngocutaneous fistula following major laryngeal surgery is not uncommon. Sumer bd, larrison d, miles ba, truelson jm, ahn c, et al. This treatment also prevents infection and causes less discomfort for the patient than traditional treatment. Fibrin gluereinforced closure of postlaryngectomy pharyngocutaneous fistula.
The method of closure of the pharynx during the ablation is of. In this report we have succesfully closed a large pharyngocutaneous fistula with free dorsalis pedis flap after ablation of oesophageal cancer. Prevention of pharyngocutaneous fistula in salvage total laryngectomy. Dec 09, 2016 pharyngocutaneous fistula after total laryngectomy slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Fistula development after salvage laryngectomy might be predicted by a history of radiotherapy or tracheostomy. The aim of the study was to establish the incidence of this complication in our series and analyse the predisposing factors. Pharyngocutaneous fistula is a common complication after laryngectomy, which increases both the morbidity and the hospital stay.
Ramadan o department of otolaryngology, aladan hospital, kuwait corresponding author. Our aim was to apply a new endoscopic surgical approach for closure of a pharyngocutaneous fistula. Autogenous jejunal free grafts were used in 3 patients when circumferential reconstruction was required. A patient developed a cervical myelopathy 20 months after radiotherapy for a carcinoma of the larynx. Most fistulas in the head and neck h and n are external fistulas in which the fistulas drain onto the skin. Its management is thus mainly based on careful conservative treatment. The original problem leading to large pharyngocutaneous fistula is the attempt at primary. The results of our study concluded that pharyngocutaneous fistula remains a troublesome complication of the early postoperative period after. The suction tubing evacuates saliva drop by drop as it forms, eliminating the need for wound dressings and long term antibiotics. A prospective study of pharyngocutaneous fistulas following total laryngectomy abstract pharyngocutaneous pc fistula is a common complication following laryngectomy. Aug 23, 2017 pharyngocutaneous fistula pcf is a problematic complication following total laryngectomy. Human growth hormone for pharyngocutaneous fistula closure.
The purpose of this study was to determine the incidence and risk factors for the fistula at the department of otorhinolaryngology and head and neck surgery in ljubljana, slovenia between 2007 and 2012. On postoperative day 5, a pharyngeal fistula and neck abscess. Otolaryngol open access j how to reduce pharyngocutaneous fistula incidence. Orocutaneous ocf and pharyngocutaneous fistula pcf.
Patients presented with fistulae from one to 18 months in duration. A after tubed rectus free flap to divert fistula toward base of tongue region. The postoperative course was complicated by delayed flap failure and development of a pcf. Various treatment strategies for the closure of pcfs were reported in the. One patient underwent radial forearm free flap closure and developed pcf. A retrospective, matchpaired analysis of 86 patients who developed fistula after total. Postoperative pharyngocutaneous fistulas are the relatively frequent complications of total laryngooesophagectomy. Objective although the majority of pharyngocutaneous fistulas close spontaneously with conservative measures, 20% to 30% of patients do not respond to this approach, thereby necessitating major reconstruction with adjacent or free tissue transfers. Pcf significantly increases morbidity, length of hospitalization, and cost of care, in addition to delaying the start of indicated adjuvant therapy 1.
Staged free flaps in closure of pharyngocutaneous fistula, after failure of primary closure in salvage laryngectomy. Jejunal free flap for laryngeal reconstruction using antibiotic, anti gerd medication and collagen patch may decrease. Peat et al published findings from 3 cases treated with a radial free flap plus. This is a retrospective study comprising 55 patients who underwent total laryngectomy. It is managed predominantly via conservative techniques, but in cases of a large orifice or a substantial loss of surrounding soft tissue, surgical management is mandatory. The management of this problem increases hospitalization time and delays initiation of postoperative radiotherapy, w.
Pharyngocutaneous fistula after total laryngectomy. Pharyngocutaneous fistula is the most common complication of total laryngectomy. Pdf pharyngocutaneous fistula following laryngectomy. Free flaps radial forearm free flap in conjunction with the montgomery salivary bypass tube dorsalis pedis flap is a suitable choice in the management of large pharyngocutaneous fistula. Pharyngocutaneous fistula pcf is a typical complication after total laryngectomy. Dorsalis pedis, flap, pharyngocutaneous fistula eur j gen med 2007. The occurrence of pharyngocutaneous fistula after oncologic head and neck. Mri in radiationinduced myelopathy and pharyngocutaneous fistula. Clinical scenario 54 yearold man sp 35 doses of 2 gray rt over 7 weeks for a t3nomo squamous cell carcinoma of the right vocal cord 6 months later undergoes biopsy because of suspicion of. Risk factors for pharyngocutaneous fistula after total. The development of a pharyngocutaneous fistula represents a complication of total laryngectomy that is usually selflimiting. Pharyngocutaneous fistula and delay in free oral feeding.
Pharyngocutaneous fistula pcf is the communication of the digestive tract with the cervical skin which originates the appearance of saliva on the skin surface after swallowing at the level of the surgical incision around the tracheostoma the continuous flow of saliva is the main factor involved in hinder. The vac system is a feasible treatment option for closing head and neck. Mar 17, 2015 abstract background risk factors for pharyngocutaneous fistula and associated delay in free oral feeding after pharyngolaryngectomy for patients with hypopharyngeal cancer remain uncertain. It is managed predominantly via conservative techniques, but in cases of a large orifice or a substantial loss. Pharyngocutaneous fistula following total laryngectomy scielo. Postlaryngectomy stricture and pharyngocutaneous fistula. Closure of postlaryngectomy pharyngocutaneous fistulae isaac a bohannon1, william r carroll2, j scott magnuson2 and eben l rosenthal2 abstract background. A novel method of preventing pharyngocutaneous fistula.
It leads to increased morbidity, delay in adjuvant treatment, prolonged hospitalization and an increase in treatment costs. Pharyngocutaneous fistula following total laryngectomy. On the day before surgery, the patient receives antibiotic treatment with a. Pharyngocutaneous fistulas after salvage laryngectomy. A radiationinduced pharyngocutaneous fistula, confirmed histologically, appeared a month later. Original article pharyngocutaneous fistula and delay in free oral feeding after pharyngolaryngectomy for hypopharyngeal cancer sayaka suzuki, md,1,2 hideo yasunaga, md, phd,1 hiroki matsui, mph,1 hiromasa horiguchi, phd,3 kiyohide fushimi, md, phd,4. Case report of a patient diagnosed with advanced hypopharyngeal cancer who underwent surgical resection and free flap reconstruction. Harris, dds, md, nashville, tennessee over a century has passed since billroth reported the first pharyngocutaneous fistula after a partial laryngectomy for head and neck cancer 1. Although radiation myelopathy was suspected, tumour recurrence could not be excluded. Disagreement remains regarding predisposing factors. Pdf case report pharyngocutaneous fistula closure using.
Prediction of pharyngocutaneous fistula and survival after. The method of closure of the pharynx during the ablation is of importance in preventing fistula formation. Such a complication results in prolonged time to oral feeding, hospitalization. Flap surgery was a criterion for subject exclusion. Two types of pharyngeal closure procedures were performed. In this study we divided the fistula into early fistula which occurred in the first 30 days postoperative and late fistula which occurred after 30 day. Effectiveness of recombinant human growth hormone for pharyngocutaneous fistula closure. Surgical repair of postlaryngectomy pharyngocutaneous fistulas. Tissue in the field of radiation treatment undergoes multiple types of. A pharyngocutaneous fistula is the most common complication following laryngectomy. The cervical esophagus was successfully reconstructed, facilitating swallowing function, in a onestage. Pharyngocutaneous fistula is a common complication of total laryngectomy.
Pharyngocutaneous fistula 3 of 3 patient receiving suction drain treatment. The purpose of this study was to find a correlation between closure technique in pharyngeal closure and outcomes of both pharyngocutaneous fistula and. Spontaneous closure with local wound care was noted in 5 patients 83. This study examines perioperative factors predicting pcf following total laryngectomy using a large multicenter data registry. Closure of postlaryngectomy pharyngocutaneous fistulae ncbi.
Pharyngocutaneous fistula after total laryngectomy dr. Although a number of factors that result in pc fistula. This article will focus on the two types of fistula that arise as complications after head and neck surgery. A metaanalysis of postlaryngectomy pharyngocutaneous fistula. Characterized by a salivary leak developing from the pharyngeal closure to the skin, which indicates a breakdown of the pharyngeal suture line or insufficient. This study examined the risk factors of pharyngocutaneous fistula development and survival in 103 patients who underwent salvage laryngectomy. Pharyngocutaneous fistula appeared in 20% 630 patients. A novel approach to closure of a pharyngocutaneous fistula.
Pdf closure of postlaryngectomy pharyngocutaneous fistulae. Feb 24, 2015 the aim of this study was to establish the incidence, risk factors, and the management of pharyngocutaneous fistula pcf after primary and salvage total laryngectomy. We evaluate outcomes in patients who required repair of a fistula after attempted primary. Closure of postlaryngectomy pharyngocutaneous fistulae. The management of pharyngocutaneous fistula jama network. Pharyngocutaneous fistula, or pharyngostoma, is a common complication occurring between the 2nd and 23rd postop day after total laryngectomy tl or total pharyngolaryngectomy tpl. Orocutaneous and pharyngocutaneous fistula closure using. A wide range of potential risk factors has been suggested. Ramadan o department of otolaryngology, aladan hospital, kuwait. Pdf effectiveness of recombinant human growth hormone. Cureus endoscopic repair of pharyngocutaneous fistula.
Pdf fibrin gluereinforced closure of postlaryngectomy. Pharyngocutaneous fistula request pdf researchgate. All patients required free flap repair for definitive fistula management. These procedures carry considerable risk, particularly in patients with medical comorbidities or a history of prior surgeryradiation. The continuous salivary leak is very much troublesome for the patients. Management of postoperative fistula in head and neck surgery. The fistula lay just anterior to the level of the spinal cord lesion. Closure of salvage laryngectomy defects with vascularized tissue remains controversial. Laryngectomy, free flap, pharyngocutaneous fistula, head.
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