The Management of Pharyngocutaneous Fistula

Abstract

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.