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Anales de Otorrinolaringología Mexicana

2006, Number 1

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Otorrinolaringología 2006; 51 (1)

Surgical closure of the post-laryngectomy pharyngocutaneous fistula: technique note

Ferbeyre BL, Sánchez AG, Hidalgo GA, Arteaga GJL, Cruz GP

Language: Spanish
References: 37
Page: 26-32
PDF size: 330.19 Kb.


ABSTRACT

BACKGROUND
Pharyngocutaneous fistula is the most common complication following total laryngectomy.

OBJECTIVE
To determine the results using different surgical procedures to repair this complication, highlighting some aspects in the management of fistulae concerning techniques and indications.

PATIENTS AND METHOD
We reviewed 115 consecutive patients who underwent total laryngectomy for squamous cell carcinoma of the larynx, most of them operated at the National Institute of Oncology and Radiobiology in Havana, Cuba. A pharyngocutaneous fistula needing surgical closure was developed in 18 patients. Information was collected from medical charts and processed in a computed database.

RESULTS

A pharyngocutaneous fistula was developed in 43 patients (37.3%), which represents an improvement comparing our previous report of 65%. Surgical closure was performed in 18 cases (41.8%). Spontaneous closure with local wound care was achieved in 25 patients (58.1%). Twelve patients (66.6%) achieved wound closure in the first surgical attempt, and oral feeding was established between 10 to 14 days postoperatively. Pharyngocutaneous fistula developed again in six patients (33.3%) and four of them closed spontaneously.

DISCUSSION
Selection of closure technique was influenced by several local factors at the recipient site. A review of the different techniques performed was made highlighting details concerning prevention of complications. Recent reports of new techniques in the literature were mentioned.

CONCLUSIONS
Closure of the pharynx is important to avoid failure. The leakage of saliva through the tissues produces infection and sepsis, risking the viability of the flaps employed. The good selection and performance of these techniques, as well as the comprehensive management of the patient are the basis of success and the solution of these problems.


REFERENCES

  1. Ogura J. Laryngectomy and radical neck disection for carcinomas of the larynx. Trans Am Acad Ophthalmol Otolaryngol 1951;56:785-808.

  2. Kirshner JA, Scaltlif JF. Disabilities resulting from healing salivary fistula. Arch Otolaryngol 1902;75:46-54.

  3. Hendrick JW. Surgical treatment of larynx and hypopharynx. Cancer 1964;7:269-87.

  4. Dejong DC, Struben WH. Pharyngeal fistula after laryngectomy. J Laryngol Otol 1962;75:46-54.

  5. Lavelle RJ, Maw AR. The etiology of post-laringectomy pharyngocutaneous fistula. J Laryngol Otol 1972;86:785-93.

  6. Dedo HH, Alonso WA, Ogura JH. Incidence, predisposing factors and outcome of faringocutaneous fistulae complicating head and neck cancer surgery. Ann Otol Rhinol Laryngol 1975;84:833-40.

  7. Horgan EC, Dedo HH. Prevention of minor and major fistulae after laryngectomy. Ann Otol Rhinol Laryngol 1998;90:123-30.

  8. Johansen LV, Overgoard J, Elbrond AN. Pharyngocutaneous fistulae after laryngectomy. Cancer 1988;61:673-8.

  9. Apligliano F. Use of nasogastric tube after total laryngectomy. Is it truly necessary? Ann Otol Rhinol Laryngol 1990;99:513-4.

  10. Combe AW, Jones AS. Radiotherapy and complications of laryngectomy. J Laryngol Otol 1993;107:130-2.

  11. Papazoglou G. Pharyngocutaneous fistulae after total laryngectomy: incidence, cause and treatment. Ann Otol Rhinol Laryngol 1994;103:801-5.

  12. Fradis M. Post laryngectomy pharyngocutaneous fistulae: a still unsolved problem. J Laryngol Otol 1995;109:221-4.

  13. Soylu L, Kiroglu M, Aydogan B, et al. Pharyngocutaneous fistula following laryngectomy. Head Neck 1998;20:22-25.

  14. Ferbeyre Binelfa L, Moret Montano A. Fístula faringocutánea. Análisis de 40 laringectomías. Rev Cubana Oncol 2001;17(2):95-100.

  15. Rodríguez-Cuevas S. Oral feeding after total laryngectomy for endolaryngeal cancer. Eur Arch Otorhinolaryngol 1995;252:130-2.

  16. Violaris N, Bridger M. Prophylactic antibiotics and post laryngectomy pharyngocutaneus fistulae. J Laryngol Otol 1990;104:225-8.

  17. Gillies HD. Experiences with tube pedicle flaps. Surg Gynecol Obstet 1935;60:291-5.

  18. Di Benedetto G, Aquinati A, Pierangeli M, Scalise A, Bertani A. From the “charretera” to the supraclavicular fascial island flap: revisitation and further evolution of a controversial flap. Plast Reconstr Surg 2005;115(1):70-76.

  19. Pallua N, Machens HG, Rennekampff O, Becker M, Berger A. The fasciocutaneous supraclavicular artery island flap for releasing postburn mentosternal contractures. Plast Reconstr Surg 1997;99(7):1878-84.

  20. Pallua N, Magnus NE. The tunneled supraclavicular island flap: an optimized technique for head and neck reconstruction. Plast Reconstr Surg 2000;105(3):842-51.

  21. Tiwari RM, Gorter H, Snow GB. Experiences with the deltopectoral flap in reconstructive surgery of the head and neck. Head Neck Surg 1981;3(5):379-83.

  22. Sofferman RA. Unusual uses of the deltopectoral flap. Laryngoscope 1979;89(8):1326-35.

  23. Ariyan S. The pectoralis major myocutaneous flap: a versatile flap for reconstruction in the head and neck area. Plast Reconstr Surg 1979;63:73.

  24. Tansini I. Sopra il mio nuovo processo cli amputazione della mamella. Gazz Med Ital 1906;4:57.

  25. Mullbauer W, Olbrisch R. The latissimus dorsi myocutaneous flap for breast reconstruction. Chir Plastica 1977;4:27.

  26. Quillen CG. Latissimus dorsi myocutaneous flap in head and neck reconstruction. Plast Reconstr Surg 1979;63:664-70.

  27. Quillen CG, Shearin JC, Giorgiade NC. Use of the latissimus dorsi myocutaneous island flap for reconstruction of the head and neck area. Case report. Plast Reconstr Surg 1978;62:113-6.

  28. Sabatier RE, Bakamjian VY. Transaxillary latissimus dorsi flap reconstruction in head and neck cancer. Limitations and refinements in 56 cases. Am J Surg 1985;150:426-34.

  29. Ferbeyre Binelfa L, Vázquez Cimadevilla JM, Hidalgo González A, Arteaga Gattorno JL, Sánchez Acuña JG. Colgajo pediculado del músculo dorsal ancho: aplicaciones en cirugía reconstructiva oncológica de cabeza y cuello. Oncologia (Barcelona) 2003;26(7):197-204.

  30. Gupta AK, Bhasin D, Shah R. Closure of post laryngectomy pharyngocutaneous fistula with sternocleidomastoid muscle flap. Ann Acad Med Singapore 1983;12(2 Suppl):407-10.

  31. Rubin JS. Repair of post-laryngectomy pharyngeal fistulae. J Laryngol Otol 1989;103(3):302-5.

  32. Olasz L, Nemeth A, Nyarady Z. Surgical closures of oropha-ryngocutaneous fistulas. Plast Reconstr Surg 2000;106(7):1577-81.

  33. Fabrizio T, Donati V, Nava M. Repair of the pharyngocutaneous fistula with a fasciocutaneous island flap pedicled on the superficial temporalis artery. Plast Reconstr Surg 2000;106(7):1573-6.

  34. Balakrishnan C, Sylora RL, Graff N. Repair of the pharyngocutaneous fistula with a fasciocutaneous island flap pedicled on the superficial temporal artery. Plast Reconstr Surg 2001;108(3):796-7.

  35. Cunha-Gomes D, Kavarana NM. The surgical treatment of post-laryngectomy pharyngocutaneous fistulae. Acta Chir Plast 2001;43(4):115-8.

  36. Nakatsuka T, Harii K, Ebihara S, Saikawa M, et al. Closure of large pharyngo-oesophageal fistulas with free flap transfer after resections for cancer. Scand J Plast Reconstr Surg Hand Surg 1998;32(2):163-70.

  37. Redaelli de Zinis LO, Ferrari L, Tomenzoli D, Premoli G, et al. Postlaryngectomy pharyngocutaneous fistula: incidence, predisposing factors, and therapy. Head Neck 1999;21(2):131-8.




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