Document Type : Case series
Authors
1
Department of otorhinolaryngology, faculty of medicine, Mashhad university of medical sciences, Mashhad, Iran
2
otorhinolaryngology research center, tehran university of medical sciences, tehran, Iran
3
faculty of engineering, ferdowsi university of masshad, iran
10.22038/rcm.2026.93527.1575
Abstract
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 24 patients with PCF out of 315 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 42 to 79 years old, with an average of 62.8 years old.
15 cases (62.5%) had a history of radiotherapy, 2 were diabetic (8%), and the average hemoglobin was 12.82 gr/dl with an average blood albumin of 3.18 gr/dl. 3 cases (12.5%) had positive surgical margins, and neck dissection was done for 22 (91.6%).
6 patients (25%) responded to conservative management, with surgery performed for those who did not respond. Closure of the fistula using SCM muscle flap was done for 7 cases (29.16%), 3 (12.5%) were treated using PM flap, and other pedicled flaps were used in one case each. Successful management was achieved using RFFF for 2 patients (8.33%).
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.
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