Current Treatment of Postoperative Head and Neck Fistulas Utilizing Negative Pressure Wound Therapy

Abstract

Postoperative pharyngocutaneous fistula after head and neck surgery is a devasting complication that increases hospitalization time and delays the initiation of oral intake and postoperative adjuvant therapy. Although it is commonly experienced, the treatment strategy differs greatly according to the size and site of the fistula and the preference of the surgeon, and a standard therapy remains to be established.Since it was first reported in 1997, negative pressure wound therapy (NPWT) has been widely applied in the treatment of complicated intractable wounds all around the body. However, its use in the treatment of head and neck fistulas has been less frequent because of the numerous undulations of the skin on the surface of the head and neck, which make an airtight seal difficult to achieve. In addition, salivary contamination and possible air leakage from the fistula are major obstacles in applying NPWT to head and neck fistulas.We have actively applied NPWT in the management of head and neck fistulas and have successfully treated these complicated wounds. Thorough wound bed preparation and the application of hydrocolloid materials around the wound edge have enabled the continuation of NPWT without leakage and infection. Incisional drainage performed a small distance from the location of the fistula was helpful for avoiding leakage during NPWT.In this article, we present our current treatment strategy utilizing NPWT for head and neck fistulas and delineate the tips for avoiding leakage during NPWT.