Pectoralis Major Myocutaneous/Myofascial Flap and Split Skin Grafting for Repair of Post Laryngectomy Pharyngo Cutaneous Fistula: An Undemanding and a Reliable Solution.

Abstract

Pharyngo cutaneous fistula occurs in 16-32% of cases after laryngectomy. Repair of a non healing fistula is a reconstructive challenge due to inherent problems like malnutrition, lung infection, infected and soiled neck wound, irradiated neck field and hypothyroid status. As the defect is composite involving the neck and the aero digestive tract, there is requirement for two epithelial surfaces. The selected flaps should be thin and rigid to maintain a patent food passage and an unobstructed tracheostoma. From January 2008 to December 2016 we operated 14 cases of post laryngectomy pharyngo cutaneous fistula. 12 cases had undergone radiotherapy before laryngectomy. Duration of the fistula was 2-9months. There was history of previous reconstructive attempts in four cases. The size of the neck defects ranged from 2cm×4cm to 4cm×8cm. In four cases, primary pharyngeal repair, Pectoralis major myofascial flap reinforcement and split skin grafting was done. In 10 cases, pharyngeal repair by Pectoralis major myocutaneous flap and split skin graft was done. Follow up was for 3months to 3years. In 13 cases, the fistula and the neck wound healed well and there was no recurrence of the fistula. Patients were on normal oral diet. One patient succumbed to the disease due to tumour recurrence at the tracheostomy site. We propose PMMF/PMMC flap and SSG for the reconstruction of post laryngectomy pharyngocutaneous fistula as an undemanding and a reliable solution.