Therapy of iatrogenic pharyngocutaneous fistulas--possibilities of surgical treatment

Abstract

During tumor surgery of the upper respiratory and digestive tract, pharyngocutaneuos fistulas may occur postoperatively. Predisposing factors are tissue disorders, as can be seen after radiation therapy or wound infections. The aim of this study was to create a systematic approach to the treatment of such complications. Patient charts of oncologic patients with postoperative salivary fistulas were analysed retrospectively. According to the surgical technique used for treating these fistulas, a systematic strategy for the therapeutic management of this complication has been created. Out of 212 operatively treated tumor patients with pharyngeal reconstruction, 23 developed pharyngocutaneous fistulas. A significant higher incidence could be observed in patients with wound healing disorders or after radiotherapy. The recurrence rate of salivary fistulas has shown to be comparably high when only single layer muscular flaps were used. The lowest rate of recurrence could be observed after pharyngeal reconstruction using myocutaneous flaps. In only 7 % of our cases, a microvascular anastomosis was possible, due to the vascular status. In 85 % of our cases, additional fasciocutaneous flaps had to be integrated for complete wound closure. This became necessary mainly because of necrosis and dehiscence. In 3 cases of severe wound healing disorders with recurrent fistulas, additional therapeutic options such as hyperbaric oxygen therapy lead to complete remission. For the definitive treatment of postoperative salivary fistulas, especially in patients with wound healing disorders, a concept of therapeutic options using myocutaneous flaps in combination with fasciocutaneous flaps, depending on the location, is necessary.