Treatment Modalities For Pharyngocutaneous Fistula Following Total Laryngectomy: A case series

Pharyngocutaneous Fistula (PCF) is a life-threatening complication following total laryngectomy. This complication prolongs hospitalization and increases costs, and may lead to delays in postoperative radiotherapy. However, there is limited evidence regarding different management strategies, especially surgical treatments, for these patients. Sternocleidomastoid (SCM), Pectoralis Major (PM), submental island, supraclavicular, infrahyoid flaps, and Radial Forearm Free Flap (RFFF) are the most practical pedicled and free flaps for PCF surgical treatment. In this study, we evaluated ۲۴ patients with PCF out of ۳۱۵ total laryngectomy patients. The management, including conservative and surgical treatments, was discussed, and risk factors for PCF occurrence were reported.The patients' ages ranged from ۴۲ to ۷۹ years old, with an average of ۶۲.۸ years old. ۱۵ cases (۶۲.۵%) had a history of radiotherapy, ۲ were diabetic (۸%), and the average hemoglobin was ۱۲.۸۲ gr/dl with an average blood albumin of ۳.۱۸ gr/dl. ۳ cases (۱۲.۵%) had positive surgical margins, and neck dissection was done for ۲۲ (۹۱.۶%).۶ patients (۲۵%) responded to conservative management, with surgery performed for those who did not respond. Closure of the fistula using SCM muscle flap was done for ۷ cases (۲۹.۱۶%), ۳ (۱۲.۵%) were treated using PM flap, and other pedicled flaps were used in one case each. Successful management was achieved using RFFF for ۲ patients (۸.۳۳%).Treatment modalities first include conservative management, with surgical treatments using pedicled or free flaps as mandatory in cases of first-line failure. The selective flap is determined based on fistula characteristics and patient history.

کلیدواژه ها:

Total laryngectomy ، Pharyngocutaneous Fistula (PCF) ، Pedicled flap ، Radial Fore Arm Free Flap (RFFF)