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ISSN 1405-0625 (Print)

2021, Number 2

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Cir Plast 2021; 31 (2)

Management of pharyngocutaneous fistulas with microvascular flaps in patients undergoing pharyngeal laryngectomy and immediate reconstruction for advanced hypopharyngeal carcinoma

Parra-Márquez M, León-Camacho H, Trejo-Meyer M

Language: Spanish
References: 16
Page: 62-67
PDF size: 372.70 Kb.


ABSTRACT

Pharyngeal cancer is an aggressive neoplasm, and hypopharyngeal cancer has the worst prognosis of all squamous cell carcinomas of the head and neck. In the last 10 years, the author operated on 12 patients for radical laryngopharyngectomy and performed immediate reconstruction with fasciocutaneous microvascular flaps, at UMAE No. 21 of the Mexican Institute of Social Security in Monterrey, Nuevo León, Mexico. Four patients (33.3%) had salivary fistulas, of which, 2 yielded to conservative management with a nasogastric tube for three weeks; the other two patients did not yield to conservative handling because they had short and anterior paths, close to the laryngeal stoma. Salivary fistulas are a frequent complication in pharyngeal reconstructions with microvascular flaps. If there is no closure with conservative management for four weeks, the option of another microvascular flap for closure should be considered. The anterolateral thigh flap is an excellent option in lean patients' low-fat flap can be obtained and does not obstruct the tracheal stoma. Likewise, the superficial circumflex artery perforator flap is ideal in patients with a fat pad on the thighs, where the anterolateral flap near the tracheal stoma is too thick for reconstruction.


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