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Semin Plast Surg 2020; 34(04): 299-304
DOI: 10.1055/s-0040-1721825
Review Article

Fistula Management in Head and Neck Cancer

Anthony Sanchez
1   Department of Otolaryngology – Head & Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
,
Ethan Frank
1   Department of Otolaryngology – Head & Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
,
Jared Inman
1   Department of Otolaryngology – Head & Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
,
Weitao Wang
2   Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
,
Arya Namin
3   Department of Otolaryngology – Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri
,
Yadranko Ducic
2   Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Abstract

Fistulas in head and neck cancer patients are a common and challenging issue. Despite their commonality, there is little consensus regarding optimal treatment strategies or in preventative measures that might be taken preoperatively. A general knowledge and understanding of what factors correlate with fistula formation can assist a surgeon in optimizing a patient for surgery, thus decreasing prevalence. In addition, surgical techniques can aid in both the prevention and treatment of fistulas once they form. This review details risk factors for fistula formation, the use of vascularized tissue as a preventative measure, conservative and nonconservative treatment of fistulas, and possible strategies to decrease the likelihood of their formation.

Keywords

fistula - head and neck cancer - regional flap - free flap - laryngectomy


Publication History

Article published online:
24 December 2020

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Virtaniemi JA, Kumpulainen EJ, Hirvikoski PP, Johansson RT, Kosma VM. The incidence and etiology of postlaryngectomy pharyngocutaneous fistulae. Head Neck 2001; 23 (01) 29-33
    CrossrefPubMedGoogle Scholar
  • 2 Patel UA, Moore BA, Wax M. et al. Impact of pharyngeal closure technique on fistula after salvage laryngectomy. JAMA Otolaryngol Head Neck Surg 2013; 139 (11) 1156-1162
    CrossrefPubMedGoogle Scholar
  • 3 Dedivitis RA, Aires FT, Cernea CR, Brandão LG. Pharyngocutaneous fistula after total laryngectomy: systematic review of risk factors. Head Neck 2015; 37 (11) 1691-1697
    CrossrefPubMedGoogle Scholar
  • 4 Klozar J, Cada Z, Koslabova E. Complications of total laryngectomy in the era of chemoradiation. Eur Arch Otorhinolaryngol 2012; 269 (01) 289-293
    CrossrefPubMedGoogle Scholar
  • 5 Mattioli F, Bettini M, Molteni G. et al. Analysis of risk factors for pharyngocutaneous fistula after total laryngectomy with particular focus on nutritional status. Acta Otorhinolaryngol Ital 2015; 35 (04) 243-248
    PubMedGoogle Scholar
  • 6 Khanh NT, Iyer G. Management of post-operative fistula in head and neck surgery: sweeping it under the carpet?. World J Otorhinolaryngol 2015; 5 (04) 93-104
    CrossrefPubMedGoogle Scholar
  • 7 Basheeth N, O'Leary G, Sheahan P. Pharyngocutaneous fistula after salvage laryngectomy: impact of interval between radiotherapy and surgery, and performance of bilateral neck dissection. Head Neck 2014; 36 (04) 580-584
    CrossrefPubMedGoogle Scholar
  • 8 Rosko AJ, Birkeland AC, Bellile E. et al. Hypothyroidism and wound healing after salvage laryngectomy. Ann Surg Oncol 2018; 25 (05) 1288-1295
    CrossrefPubMedGoogle Scholar
  • 9 Girkar F, Thiagarajan S, Malik A. et al. Factors predisposing to the development of orocutaneous fistula following surgery for oral cancer: experience from a tertiary cancer center. Head Neck 2019; 41 (12) 4121-4127
    CrossrefPubMedGoogle Scholar
  • 10 Paleri V, Drinnan M, van den Brekel MWM. et al. Vascularized tissue to reduce fistula following salvage total laryngectomy: a systematic review. Laryngoscope 2014; 124 (08) 1848-1853
    CrossrefPubMedGoogle Scholar
  • 11 Benson EM, Hirata RM, Thompson CB. et al. Pharyngocutaneous fistula after total laryngectomy: a single-institution experience, 2001-2012. Am J Otolaryngol 2015; 36 (01) 24-31
    CrossrefPubMedGoogle Scholar
  • 12 Guimarães AV, Aires FT, Dedivitis RA. et al. Efficacy of pectoralis major muscle flap for pharyngocutaneous fistula prevention in salvage total laryngectomy: a systematic review. Head Neck 2016; 38 (Suppl. 01) E2317-E2321
    CrossrefPubMedGoogle Scholar
  • 13 Microvascular Committee of the American Academy of Otolaryngology-Head & Neck Surgery*. Salvage laryngectomy and laryngopharyngectomy: Multicenter review of outcomes associated with a reconstructive approach. Head Neck 2019; 41 (01) 16-29
    CrossrefPubMedGoogle Scholar
  • 14 Tan NC, Lin PY, Kuo PJ. et al. An objective comparison regarding rate of fistula and stricture among anterolateral thigh, radial forearm, and jejunal free tissue transfers in circumferential pharyngo-esophageal reconstruction. Microsurgery 2015; 35 (05) 345-349
    CrossrefPubMedGoogle Scholar
  • 15 López F, Obeso S, Camporro D, Fueyo A, Suárez C, Llorente JL. Outcomes following pharyngolaryngectomy with fasciocutaneous free flap reconstruction and salivary bypass tube. Laryngoscope 2013; 123 (03) 591-596
    CrossrefPubMedGoogle Scholar
  • 16 Withrow KP, Rosenthal EL, Gourin CG. et al. Free tissue transfer to manage salvage laryngectomy defects after organ preservation failure. Laryngoscope 2007; 117 (05) 781-784
    CrossrefPubMedGoogle Scholar
  • 17 Powell J, Ullal U, Ahmed O, Ragbir M, Paleri V. Tissue transfer during salvage laryngectomy following chemoradiation to prevent pharyngocutaneous fistula. J Laryngol Otol 2014; 128 (04) 365-367
    CrossrefPubMedGoogle Scholar
  • 18 Righini CA, Bettega G, Lequeux T, Chaffanjeon P, Lebeau J, Reyt E. Use of tubed gastro-omental free flap for hypopharynx and cervical esophagus reconstruction after total laryngo-pharyngectomy. Eur Arch Otorhinolaryngol 2005; 262 (05) 362-367
    CrossrefPubMedGoogle Scholar
  • 19 Gil Z, Gupta A, Kummer B. et al. The role of pectoralis major muscle flap in salvage total laryngectomy. Arch Otolaryngol Head Neck Surg 2009; 135 (10) 1019-1023
    CrossrefPubMedGoogle Scholar
  • 20 Fung K, Teknos TN, Vandenberg CD. et al. Prevention of wound complications following salvage laryngectomy using free vascularized tissue. Head Neck 2007; 29 (05) 425-430
    CrossrefPubMedGoogle Scholar
  • 21 Hanasono MM. Use of reconstructive flaps following total laryngectomy. JAMA Otolaryngol Head Neck Surg 2013; 139 (11) 1163
    CrossrefPubMedGoogle Scholar
  • 22 Hyman J, Disa JJ, Cordiero PG, Mehrara BJ. Management of salivary fistulas after microvascular head and neck reconstruction. Ann Plast Surg 2006; 57 (03) 270-273 , discussion 274
    CrossrefPubMedGoogle Scholar
  • 23 Molteni G, Sacchetto A, Sacchetto L, Marchioni D. Optimal management of post-laryngectomy pharyngo-cutaneous fistula. Open Access Surgery 2020; 13: 11-25
    CrossrefPubMedGoogle Scholar
  • 24 Myers EN. The management of pharyngocutaneous fistula. Arch Otolaryngol 1972; 95 (01) 10-17
    CrossrefPubMedGoogle Scholar
  • 25 Kwon D, Genden EM, de Bree R. et al. Overcoming wound complications in head and neck salvage surgery. Auris Nasus Larynx 2018; 45 (06) 1135-1142
    CrossrefPubMedGoogle Scholar
  • 26 Diallo BK, Lacher-Fougere S, Baltazart B, Traissac L, Houliat T. Results of alginate and hypertonic solution in wound healing of head and neck cancers [in French]. Rev Laryngol Otol Rhinol (Bord) 2008; 129 (4-5): 289-292
    PubMedGoogle Scholar
  • 27 Ganacias-Acuna EF. Active Leptospermum honey and negative pressure wound therapy for nonhealing postsurgical wounds. Ostomy Wound Manage 2010; 56 (03) 10-12
    PubMedGoogle Scholar
  • 28 Cooper R. Impact of honey as a topical treatment for wounds remains unclear. Evid Based Med 2014; 19 (01) 11
    CrossrefPubMedGoogle Scholar
  • 29 Busoni M, Deganello A, Gallo O. Pharyngocutaneous fistula following total laryngectomy: analysis of risk factors, prognosis and treatment modalities. Acta Otorhinolaryngol Ital 2015; 35 (06) 400-405
    CrossrefPubMedGoogle Scholar
  • 30 Iteld L, Yu P. Pharyngocutaneous fistula repair after radiotherapy and salvage total laryngectomy. J Reconstr Microsurg 2007; 23 (06) 339-345
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Inatomi Y, Kadota H, Yoshida S. et al. Utility of negative-pressure wound therapy for orocutaneous and pharyngocutaneous fistula following head and neck surgery. Head Neck 2020; 42 (01) 103-110
    CrossrefPubMedGoogle Scholar
  • 32 Lin FY, Huang PY, Cheng HT. Systematic review of negative pressure wound therapy for head and neck wounds with fistulas: outcomes and complications. Int Wound J 2020; 17 (02) 251-258
    CrossrefPubMedGoogle Scholar
  • 33 McLean JN, Nicholas C, Duggal P. et al. Surgical management of pharyngocutaneous fistula after total laryngectomy. Ann Plast Surg 2012; 68 (05) 442-445
    CrossrefPubMedGoogle Scholar
  • 34 Salgado CJ, Mardini S, Chen HC, Chen S. Critical oropharyngocutaneous fistulas after microsurgical head and neck reconstruction: indications for management using the “tissue-plug” technique. Plast Reconstr Surg 2003; 112 (04) 957-963
    CrossrefPubMedGoogle Scholar