Fístulas orocutâneas após cirurgia de câncer da cavidade oral: fatores de risco

Abstract

To quantify the oral cutaneous fistulae after surgery and to identify possible risk factors. A retrospective study, interesting patients that were submitted to surgery, with a two years minimum post-operative follow up. The considered variables were: sex, concomitant diseases, tabacco and alcohol use, the anesthesic and pulmonary risks, clinical stage, cervical linphadenectomy, pre or postoperative radiotherapy, accidents during the surgery, wound infection and or hematoma, pulmonary infection, surgery and reconstruction extension. In 159 patients, oral cutaneous fistulae occurred in 48 patients (30,3%): Patients stage T1 in 26,6 %,T2 in 1,8 %,T3 in 16%, and T4 in 40,3% (p=0,0138). The cases N+ developed fistulae in 22.9%, (N2c with 42,8%, (p=0,0136), those with preoperative radiotherapy in 63,6% (p=0,0346) Those with wound infection in 47,3% (p=0,0146), and those with wound deiscense in 53,7 % (p=0,0030). The fistulae rate was of 60% in the regional mucocutaneous flaps reconstruction cases, 39,2% in the myocutaneous ones and 12,5% of microsurgery ones (p=0,0286). The general rate of oral cutaneous fistulae was 30,3%. The significant factors were: T stage, cervical linphadenectomy, pre or postoperative radiotherapy, wound infection and deiscense, and the use of flaps.