Surgical Treatment of Pharyngocutaneous Fistula Requiring Extensive Neck Skin Reconstruction

Abstract

Background: Pharyngocutaneous fistula is a major complication that occurs after salvage surgery following radiotherapy for laryngeal cancer. It is characterized by extensive neck skin defects and pharyngeal defects, necessitating biplane reconstruction for surgical treatment.Methods: We retrospectively examined the surgical procedure and postoperative course of pharyngocutaneous fistula in patients with extensive neck skin defects who were operated on in our department.Results: A pectoralis major myocutaneous flap was employed for reconstruction in five cases, while the free anterolateral thigh flap was used in one. In two cases where the pectoralis major myocutaneous flap was used, reconstruction was done with two skin paddles; in one case, a skin paddle and a muscle flap with a skin graft were used for reconstruction. The patient, for whom an anterolateral thigh flap was used, underwent reconstruction using two skin paddles, each containing one perforator artery. A pectoralis major myocutaneous flap with a skin graft and a free anterolateral thigh flap yielded favorable outcomes.Conclusion: A free anterolateral thigh flap is recommended if the neck has anastomotic vessels in unilateral neck dissection. Conversely, if the use of free flaps is avoided, a pectoralis major flap with a skin paddle on the pharyngeal side and a skin graft on the muscle flap on the skin side is recommended.