Closure Of Pharyngocutaneous Fistula Research Articles

Facial Reconstruction Using Sternocleidomastoid (SCM) Flap: A Review of the Literature.

The sternocleidomastoid (SCM) flap has been used for a long time in protective coverage of major vessels, reconstruction of intraoral pharyngeal, closure of pharyngo-cutaneous fistulas, and augmentation of soft tissue defects in the oral and maxillofacial region. However, this flap is not yet commonly used due to doubtful blood supply to the flap. This flap offers favorable esthetic results, combined flap, rich vascularization, and the possibility of shifting the two heads of the muscle. Thus, this flap has been used broadly in the maxillofacial region to reconstruct the defects of the post-parotidectomy, mandible, pharynx, and floor of the mouth defects. Previous studies discussed the use of a SCM flap following parotidectomy. However, few studies explained the use of SCMs in facial reconstruction. This study aims to review published articles discussing the use of SCMs for facial reconstruction.

Non-Surgical Strategies for Assisting Closure of Pharyngocutaneous Fistula after Total Laryngectomy: A Systematic Review of the Literature.

Background: Pharyngocutaneous fistula (PCF) is a frequent complication after total laryngectomy, with an incidence of up to 65%. Many conservative or invasive approaches are available and the choice among them is usually made on a case-by-case basis. The aim of the present review is to critically summarize the available evidence of the effectiveness of the non-surgical management of PCF. Methods: A systematic review and a meta-analysis of the literature were conducted, according to the PRISMA guidelines. Studies investigating botulinum toxin therapy, scopolamine transdermal patch, hyperbaric oxygen therapy (HBOT), and negative pressure wound therapy (NPWT) were assessed. Complete fistula closure after the initiation of non-surgical treatment was the main outcome. Results: After the application of selection criteria, a total of seven articles and 27 patients were included in the present review. All the eligible studies were descriptive case series, while only one article used a standard group as a comparison. The mean age was 63.3 and 14 patients (51.9%) had previously received RT. The reported comorbidities were diabetes, ischemic heart disease, hypertension, dyslipidemia, COPD, and atrial fibrillation. With a mean healing time of 25.0 days, the overall success rate was 92.6%. Conclusions: Non-surgical treatment of PCF is only based on the experience of small series. Although success rates seem promising, the absence of properly designed comparative studies does not allow us, at present, to identify ideal candidates for these non-invasive management strategies for PCF.

Endoscopic negative pressure therapy of apost-laryngectomy pharyngocutaneous fistula-first report of anew therapeutic method. German version

In the current first report, it is shown how apost-laryngectomy pharyngocutaneous fistula was successfully closed by endoscopic negative pressure therapy (ENPT; also termed endoscopic vacuum therapy, EVT). The duration of negative pressure treatment was 14days. Up until now, ENPT has been used for treatment of transmural defects in the rectum and esophagus. The new endoscopic method can also be used in the ENT field for closure of pharyngocutaneous fistulas.

Comparison of pharyngocutaneous fistula closure with and without bacterial cellulose in a rat model

ObjectiveThe present study aimed to compare the effects of bacterial cellulose used for closure of pharyngocutaneous fistulae, a complication of total laryngectomy, with those of primary sutures in a rat model. MethodsThirty female Sprague-Dawley underwent experimental pharyngoesophagotomy and were grouped depending on the material used for pharyngocutaneous fistula closure: group I, which received primary sutures alone, group II, which received bacterial cellulose alone; and group III, which received both. After 7 days, the rats were sacrificed. Pharyngocutaneous fistula development was assessed, the gross wound was inspected, and histological examination was conducted. ResultsPharyngocutaneous fistulae developed in 12 rats (41%) in all: 6 from group I (21%), 4 from group II (14%) and 2 from group III (7%). ConclusionFibroblast density and inflammatory cell infiltration were significantly greater in group III than group I. We concluded that bacterial cellulose may be useful for pharyngocutaneous fistula closure.

Closure of Pharyngocutaneous Fistula Following Salvage Surgery of Larynx Preserved Partial Pharyngectomy: Case Report

Closure of Pharyngocutaneous Fistula Following Salvage Surgery of Larynx Preserved Partial Pharyngectomy: Case Report

Effectiveness of Recombinant Human Growth Hormone for Pharyngocutaneous Fistula Closure.

ObjectivesIn laryngeal cancer, which comprises 25% of head and neck cancer, chemotherapy has come into prominence with the increase in organ-protective treatments. With such treatment, salvage surgery has increased following recurrence; the incidence of pharyngocutaneous fistula has also increased in both respiratory and digestive system surgery. We investigated the effects of recombinant human growth hormone on pharyngocutaneous fistula closure in Sprague-Dawley rats, based on an increase in amino acid uptake and protein synthesis for wound healing, an increase in mitogenesis, and enhancement of collagen formation by recombinant human growth hormone.MethodsThis study was experimental animal study. Forty Sprague-Dawley rats were separated into two groups, and pharyngoesophagotomy was performed. The pharyngoesophagotomy was sutured with vicryl in both groups. Rats in group 1 (control group) received no treatment, while those in group 2 were administered a subcutaneous injection of recombinant human growth hormone daily. On day 14, the pharynx, larynx, and upper oesophagus were excised and examined microscopically.ResultsPharyngocutaneous fistula exhibited better closure macroscopically in the recombinant human growth hormone group. There was a significant difference in collagen formation and epithelisation in the recombinant human growth hormone group compared to the control group.ConclusionThis study is believed to be the first in which the effect of recombinant human growth hormone on pharyngocutaneous fistula closure was evaluated, and the findings suggest the potential of use of growth hormone for treatment of pharyngocutaneous fistula.

Delayed platysma myocutaneous turnover flap for repair of pharyngocutaneous fistula

IntroductionPharyngocutaneous fistula (PCF) is a common and serious complication after total laryngectomy. Numerous surgical and non-surgical treatment approaches have been described. Here we describe a platysma myocutaneous turnover flap for repair of PCF. Materials and methodsPlatysma myocutaneous turnover flap is described and two patients are used as examples. ResultsRepair was initially successful in both patients; however, one patient had recurrence of fistula after her cancer recurred at the stoma. DiscussionNumerous surgical techniques have been described for repair of PCF. Here a turnover flap was used, a technique not previously described for this problem. The delay technique enhances the viability of the flap thought to be through numerous mechanisms. ConclusionThe platysma myocutaneous turnover flap is useful for closure of pharyngocutaneous fistula when non-operative measures have failed.

Coated collagen patches for closure of pharyngo-cutaneous fistulas

After laryngectomy or lateral pharyngotomy for treatment of laryngeal or hypopharyngeal cancer the occurrence of a pharyngo-cutaneous fistula is a challenging complication. Especially after previous radiotherapy and expanded surgical resections of mucosa the management is demanding. Besides the prolonged hospital stay, increased treatment costs and reduced quality of life, a delayed adjuvant treatment follows the development of a fistula. Treatment strategies range from conservative procedures comprising parenteral nutrition, antibiotics and local wound care to primary surgical closure or reconstructive tissue transfer. We report three cases of using the fibrin/thrombin-coated collagen patch TachoSil® as a solitary or adjuvant strategy in surgical treatment. In one patient primary closure of the fistula was achieved by transoral application of the collagen patch. In the other cases a not tension free primary suture was strengthened by the adjuvant use of TachoSil®. The healing process was rapid and straightforward in all patients. The use of TachoSil® may be indicated in between conservative treatment strategies and reconstructive surgery. After occurrence of a fistula the healing process is intended to be accelerated by primary closure with TachoSil® or by sealing of a primary suture.

放射線化学療法後に発生した管腔皮膚瘻に対する閉鎖法について

放射線化学療法後に発生した管腔皮膚瘻に対する閉鎖法について

Stent migration to the ileum—A potentially lethal complication after montgomery salivary bypass tube placement for hypopharyngeal stenosis after laryngectomy

Montgomery salivary bypass tubes (MSBTs) have been used for decades in the treatment of stenoses and fistulae of the hypopharynx and the cervical esophagus. Generally, MSBT use is not associated with serious complications. Only a small number of cases with severe MSBT-associated complications have been reported in the literature. We report for the first time an MSBT migration to the ileum in a laryngectomized patient who underwent surgical pharyngocutaneous fistula closure with MSBT placement. The MSBT was removed surgically via laparotomy. The patient died 15 days later due to sepsis associated with peritonitis. To avoid potentially lethal complications associated with MSBT migration into the intestinal tract, we recommend secure fixation of the MSBT to a nasogastric tube.

Results of closure of pharyngocutaneous fistulae

A further technique is described for the closure of small pharyngocutaneous fistulae. The outcome of the closure of 36 pharyngocutaneous fistulae, of all sizes is described. Type III fistulae (that is where no local tissue is available for repair) were the most difficult to heal, but success was achieved in 86% of cases overall, the stay in hospital with the size of the fistula.

Orocutaneous and Pharyngocutaneous Fistula Closure Using a Vacuum-Assisted Closure System

The vacuum-assisted closure (VAC) system is a topical negative pressure dressing that has been used extensively to manage a multitude of complicated wounds, including enterocutaneous fistula. We hypothesize that the VAC system may also facilitate the closure of orocutaneous and pharyngocutaneous fistulas. A retrospective chart review was performed. Three patients were identified. Two patients developed fistulas after undergoing salvage laryngectomy, and 1 patient developed a fistula after having a hemiglossectomy defect reconstructed by a radial forearm free flap. The VAC system was successful in closing the fistula in 2 of the 3 patients. Complete fistula closure took 3 and 11 days in the 2 cases. The 1 failure of fistula closure was due to poor collapsibility of the neck tissue along the fistula tract caused by fibrosis following prior radiotherapy. The VAC system is a feasible treatment option for closing head and neck fistulas, especially when collapsible tissue is present at the fistula site.

Use of becaplermin in the closure of pharyngocutaneous fistulas

We report on the contribution of recombinant platelet-derived growth factor-BB (becaplermin) in treating recalcitrant postlaryngectomy fistulas in two patients with head and neck cancer. Topical becaplermin was applied daily, with periodic wound assessment and photodocumentation. The two patients with persistent fistula refractory to conventional management have demonstrated rapid improvement after topical application of becaplermin. Each wound exhibited an exuberant granulation response, with a 50% decrease in the size of wound at 1 week. The patients experienced eventual closure, with none having local recurrence of their cancer at 2 years' follow-up. Becaplermin seems to be a promising addition to traditional methods of treatment for postlaryngectomy fistulas. In patients with delayed healing, future studies will be required to determine the overall efficacy of such biologic response modifiers in the treatment of pharyngocutaneous fistulas and other chronic wounds of the head and neck.

Closure of pharyngocutaneous fistulae with the rhomboid flap.

This technique has been used successfully in 15 cases of pharyngocutaneous or antrocutaneous fistulae. Only 1 case failed which later closed with conservative management.

Results of closure of pharyngocutaneous fistulae.

A further technique is described for the closure of small pharyngocutaneous fistulae. The outcome of the closure of 36 pharyngocutaneous fistulae, of all sizes is described. Type III fistulae (that is where no local tissue is available for repair) were the most difficult to heal, but success was achieved in 86% of cases overall, the stay in hospital with the size of the fistula.

The management of pharyngocutaneous fistula.

The appearance of pharyngocutaneous fistula following major laryngeal surgery is not uncommon. The method of closure of the pharynx during the ablation is of importance in preventing fistula formation. The original problem leading to large pharyngocutaneous fistula is the attempt at primary pharyngeal closure with insufficient pharyngeal mucosa. Local wound care and maintenance of adequate nutrition and blood volume will allow most small fistulae to heal spontaneously. Large fistulae must be closed by providing adequate epithelial lining to complete the pharyngeal wall as well as a replacement for cervical skin. The deltopectoral flap has proved to be most useful for this purpose. Its various applications are described for the closure of pharyngocutaneous fistulae.