A Novel Approach to Closure of a Pharyngocutaneous Fistula

Abstract

Objective: 1) Describe a novel approach to the management of a large pharyngocutaneous defect with the vacuum assisted closure (VAC) system. 2) Present photographs demonstrating the application of the VAC system and evolution of the defect. 3) Review other techniques described for the management of pharyngocutaneous fistulas (PCF). Method: Case report of a patient diagnosed with advanced hypopharyngeal cancer who underwent surgical resection and free flap reconstruction. The postoperative course was complicated by delayed flap failure and development of a PCF. This fistula was managed with the VAC device until the wound healed adequately to proceed with adjuvant radiation. Results: The patient intially underwent a total laryngopharyngoesophagectomy and reconstruction with an anterior lateral thigh flap. Postoperatively the patient experienced a protracted course of nausea and vomiting, resulting in PCF formation. Because of the location of the PCF near the stoma, the VAC dressing was applied with incorporation of the stoma using a laryngectomy tube with a raised flange and a salivary bypass tube in the pharyngeal defect. The patient was then successfully reconstructed in a delayed fashion after completion of adjuvant radiation with a gastro-omental free flap. The patient is currently disease free and eating and speaking well. Conclusion: This case illustrates the successful use of the VAC device in a large pharyngocutaneous defect. This novel approach allowed the use of the VAC device despite the dressing being incorporated into the patient’s stoma.